THE 

FAMILY PHYSICIAN 



AND 






A SYSTEM OF 



DOMESTIC MEDICINE. 

INCLUDING 

A TEEATISE ON MIDWIFEKY AND THE DISEASES 
PECULIAE TO WOMEN. 



BY 

E.. B. HAMMACK, M. D 



mi 



ST. LOUIS: 

SOUTHWESTERN BOOK AND PUBLISHING CO., 510 AND 512 WASHINGTON AV. 

1869. 






Entered according to Act of Congress, in the year 1869, by 

Elijah B. Hammack, M. D., 

In the Clerk's Office of the District Court of the United' States for the 
Eastern District of Missouri. 



PREFACE 



After finishing the last page I now commence to write 
the first — the preface, apology, advertisement, " puff," or 
whatever the reader may choose to call it. 

I have no apology to offer. I have done the very best 
I could in preparing the matter for this work. I have 
diligently consulted the ablest, latest and best authori- 
ties in medical literature, coming from both Europe and 
America, and have tried hard to present the accepted 
facts of the history, symptoms and treatment of diseases 
in plain, simple and common-place language, so that 
every school boy or girl of intelligence can understand- 
and comprehend them. I have given the symptoms 
plainly and laid down the treatment, not only on general 
principles, but specially, stating exactly what to give, 
how much of it to give at a time, and how often to give it. 
By this means I have placed a great amount of valuable 
information within easy reach of the common people — 
information, too ? upon which may depend their health,, 
happiness or lives, or that of those dependent upon them. 



IV PEEFACE. 

I neither deprecate nor invite criticism, believing that 
the critic has neither a very wide nor profitable field for 
his fault-finding skill. If my nnpresuming hook finds 
favor with the intelligent public, I will be content to let 
critics fume and fret, and enemies sneer and curl the lip 
with the scorn they try to feel. A few physicians, from 
selfish motives, may try to discourage the masses from 
patronizing the work, but I flatter myself that it will 
receive the hearty approval of a large majority of those 
who have kept themselves posted in the standard medical 
literature of the day. The intelligent physician wants 
an intelligent and well-informed patient : with such an 
one his labor is easy and pleasant. It is only those who 
do not know quite as much as they really should who 
try to keep the common people in ignorance in regard to 
the symptoms and treatment of disease. They fear the 
light of knowledge ; they know in it their own feeble 
light would shine but dimly. 

If there is any one subject pertaining to this life of 
more importance to mankind than another it certainly is 
that of medicine and the laws of health. This subject 
man has a perfect right to investigate, a perfect right to 
sift to the very bottom and understand most thoroughly. 
It is not only his right to do this, but it is his duty. The 
man who has a family dependent upon him — their daily 
bread depending upon his toil — has no right to be sick ; he 
has no right to violate the laws of health and life and 
thereby render himself unable to provide for those de- 



PREFACE. V 

pendent upon hini ; lie has no right to shorten his life by 
ignorance or imprudence. The Creator allotted him a 
time to live ; he made certain laws by which he should 
be governed ; these laws are immutable and must be 
obeyed : if they are, man will live out his " three score 
years and ten;" if they are violated, pain, suffering and 
premature death are the penalties. In order to be able to 
obey them man must know them. He is not born with 
that knowledge. The lower animals are born with in- 
stinct by which they are often enabled to shun danger, 
but it is not so with man ; he is born without instinct, 
without intelligence and without knowledge ; all that he 
ever knows he must learn. He knows nothing of the laws 
governing life or health but what is taught him or he 
learns by his own observation and experience. He can 
not obey these laws without knowing them ; therefore it 
is necessary that all men should be taught. For this 
purpose I offer this book as one of the texts to place in 
the hands of the people in order to accomplish this great 
work. The premature decay and death I see around me 
every day demand it. I take pleasure in offering it to 
the public on its own merit. I have not attempted to 
array a lot of certificates, medals or paid-for recommenda- 
tions ; if it has not sufficient merit to recommend it to 
the favor of an intelligent people, let it " fall still-born." 
I have diligently labored for months getting together 
facts, condensing and preparing them for the common 
reader — facts the latest and best in medical science. I 



VI PEEFACE. 

am not afraid to trust the decision to an enlightened 
public. 

It is true there is already a vast amount of literature 
in the country, "but a large class of it is of the sensation 
style that is only calculated to amuse ; it neither benefits 
nor instructs, and, in fact, is apt to produce a dis- 
position to crime that often crops out in after years. I 
heard a young lady the other day say, after reading 
Emerson Bennett's great story of the " Bandit Queen," 
that she wished she was a " Bandit Queen," or the wife 
of some dashing pirate, with a magnificent ship like the 
" Skimmer of the Seas." Such desires are the legitimate 
fruits of sensation stories ; and, while a little light read- 
ing may be beneficial, or at least relax the mind for a 
time, too much of it leads to idleness and crime. I know 
also that there is a large amount of medical literature in 
the land, but it is not adapted to the common reader ; it 
is filled with technicalities and medical terms that the 
common scholar does not understand, and he can not 
comprehend it. Medicines are called by Latin names, so 
that the most simple article can pass completely incog. ; 
and diseases are even given such names that the com- 
mon reader would not be able to recognize theni. There 
are, however, a few family or domestic practices in the 
country, but the science of medicine is progressive ; it 
has advanced as much in the last ten years as it had, 
perhaps, in half a century before. The practice has 
undergone an almost entire change ; principles that were 



PREFACE. VIE 

considered orthodox then are abandoned now and sub- 
stituted by more rational ones. The antiphlogistic 
regimen practiced then has given way to a pratice the 
very opposite — i. e., sustaining and palliative treatment in 
place of the mercury, antimony, bleeding and blistering 
that was relied upon then. Besides, great advancement 
in diagnosis has been made ; diseases that could not be 
detected then in their incipiency can now be readily diag- 
nosed and removed before they are fairly established. 
New remedies have been discovered, and old ones better 
understood. It is known now that the tincture of iron 
is a specific, almost, for erysipelas and diphtheria, while 
quinine is known to destroy malaria, and bromide of 
potassium to cure epilepsy, phthisic, &c For these and 
other reasons it will be found necessary to procure the 
very latest and best medical literature. 

During a practice of many years in the Mississippi 
Valley I have become acquainted with the type, charac- 
ter and treatment of the disease, generally prevalent in 
the South and West. I have seen the necessity of a 
work like this to place in the hands of the people. I 
believe in it I have, to a very great extent, supplied their 
wants. It is the first medical work of any importance 
ever written and published in the Mississippi Valley., 
and by a native, too, of that Valley. It remains to be 
seen what favor it will meet at the hands of the people 
of the West and South. 

I feel in every way encouraged; men competent to 



VIII P E E F A C E . 

judge, standing high in the medical profession, have seen 
the proof sheets as they came from the press, and give 
me every encouragement and assurance that it will 
succeed, while orders are coming in daily for the book. 

I feel confident that every family who look to their 
own interest and welfare will procure a hook. Heads of 
families owe it to the rising generation to give them some 
insight into the science of medicine and the simple laws 
governing life and health. 

Women ought to know, and are entitled to know, from 
some other source than the lips of a physician something 
about their peculiar organization and the ofiices they are 
called upon to perform, and the diseases peculiar to them, 
their treatment, &c, all of which are carefully and pro- 
perly detailed in plain language in this work. 

In writing the Family Physician and Guide to Health 
I have had constantly before me one cardinal object — to 
be useful. I have tried to arrange and present to the 
public a practical book in all its varied departments ; 
tried to condense as much useful knowledge into as small 
a space as possible, and bring the work fully up to the 
wants of the common reader — fully up to the advanced 
state of conservative medicine — and it is, therefore, I 
think, the most eligible book before the people. 

With a sincere desire that it may be the means of 

preventing much suffering and premature death, it is 

respectfully submitted by the 

AUTHOR 
St. Louis, Mo., November, 1869. 



INDEX. 





PAGE. 




PAGE. 


Abortion — 


601 


Arteries 


118 


Causes of 


602 


Ascites 


- 420 


Symptoms - 


- 606 


Articles of vegetable diet 63 


Habitual - 


605 


Asthma — 


508 


Treatment - 


- 606 


Bromide of 


potas- 


Absent Menstruation 


557 


sium in 


- 509 


Absinthe - 


- 86 






Absinthe drinkers - 


86 


Bacon 


54 


Abcess— 


489 


Baking 


- 48 


Acute 


489 


Baths — 


94 


Chronic 


- 491 


Turkish - 


94 


Alcoholic Drinks - 


70 


Spirit vapor 


- 98 


After Pains 


- 623 


Vapor 


100 


Amenorrhea — 


557 


Douche 


- 101 


Chronic - 


563 


Foot 


101 


Anthrax - 


- 487 


Shower 


- 102 


Anatomy 


106 


Immersion 


103 


Outlines of 


- 106 


Sponge 


- 104 


Animal diet 


- 50 


Beef 


50 


Anasarca 


422 


Beef tea 


51 


Apoplexy 


- 353 


Black vomit 


- 204 



INDEX 



PAGE. 

Bladder— 114 

Inflammation of 397 

Blood - - - 119 

Boiling — 46 

Dissolves cell walls 47 

Boils - 485 

Bones— 106 

Of the skull - 106 

Face - - - 107 

Ear - - 107 

Trunk - - 107 

Pelvis - - 108 

Upper extremities 108 

Lower " 108 

Brain— 109 

Inflammation of 363 

Breakfast - - 35 

Bronchitis — 

Acute - - - 401 

Chronic - - 403 

Broiling - - - 48 

Butter - - - 61 

Buttermilk - - 61 

Burns 468 

Canine madness - 457 
Carlbuncle - - 487 
Catarrh - - - 454 
Cessation of menstrua- 
tion - - - 573 
Cellular membrane 118 
" dropsy - 422 
Cerebritis - - - 362 



PAGE. 

Cerebro spinal menin- 
gitis - - - 373 
Chicken pox - - 310 
Chicken soup - 57 
Child-birth - - 609 
Children require little 

animal food - - 40 
Cholera — 

Epidemic - - 220 

Cause of - - 224 

Treatment - - 238 

Cholera morbus - 218 

Convulsions - - 496 

Congestion of the brain 350 

Convulsive form 354 

Apoplectic form 353 

Febrile form - 356 

Delirium form 355 

Cold ... 453 

Colic - 515 

Coffee ... 69 

Consumption - - 517 

Constipation of bowels 553 

Conception — 586 

Germ cell - 588 

Sperm ceU - - 589 

Corn ... 63 

Condiments - - 41 

Croup - - - 540 

Cynanche trachealis - 540 

" partidea 307 

Cystitis - - - 397 



INDEX. 



XI 



PAGE- 

Decree from Garden of 

Eden ... 23 

Definition of disease 120 

" of names - 120 

Delirium tremens - 433 

Diarrhea - - - 216 

Diphtheria - - 311 
Disease of circulatory 

system - - 343 
Disease of the skin - 531 
" heart 343 
Dinner - 36 
Diet — general rules 31 
Diseases peculiar to wo- 
men - - - 557 
Drinks 66 
Dried meat - - 51 
Dropsy — 414 
Of brain - - 414 
Chronic - - 417 
Of chest - - 418 
Of abdomen - 420 
Cellular - - 422 
General - - 422 
Of scrotum - - 424 
Heart - - 425 
During a meal — 43 
avoid mental excite- 
ment 43 
Dysentery - - - 212 
Dyspepsia - - 406 
Dysmenorrhea - - 565 



PAGE. 

Eggs 60 
Entero mesenteric fever 194 
Enteralgia - - - 515 
Epilepsy— 502 
Bromide of potas- 
sium in - 502 
Erysipelas - - - 335 
Exudation — 139 
Simple - 141 
Can not be cut short 149 
Causes of - - 142 
Symptoms of - 143 
Terminations of 144 
Treatment of - 144 
Eye, the - - 526 

Falling of the womb - 581 

Fever — 

Malarial - - 156 

Intermittent - 160 

Chills and - 160 

Remittent - - 171 

Bilious - - 171 

Typhus - - 182 

Continued - 182 

Typhoid - - 194 

Nervous - - 194 

Entero-mesenteric 194 

Gastric - - 194 

Yellow - - 204 

Scarlet - - 299 

Fish - 57 



XII 



INDEX 



PAGE. 

Food— 31 
Must be well chewed 44 
Fits- 
Epileptic - - 502 
Children - - 497 
Convulsion - - 496 
Flooding— 617 
Secondary - 621 
Frost bite - - - 475 
Frying 49 
Fruit - - - 63 
Functional disease of the 

heart - - - 348 

Furuncle - - 485 



PAGE. 

Heart — 

Treatment of valvu- 
lar organic disease 
of - 347 

Functional disorders 
of - - 348 

Hepatitis - - - 385 
Hemorrhoids - - 439 
Herpes circinatus - 532 
Hydrocephalus — 414 

Chronic - -^ 417 
Hydropericardium - 425 
Hydrophobia - 457 

Hydrocele - - 424 

Hysteria - - 548 



Gall bladder - - 113 


Hysterics - 


548 


Game - 56 






Gangrene - - - 471 


Inflammation — 


139 


Gastritis - - - 388 


Of the brain 


363 


General law of nutrition 131 


Chronic 


369 


Gout - 243 


Of the liver 


385 


Glands - - - 117 


Of the stomach 


388 


Gravel and stone — 444 


Chronic - 


391 


Treatment of - 446 


Of the spleen - 


393 


Nephritic colic 446 


Of the kidneys - 


394 




Chronic 


396 


Health 29 


. Of the bladder - 


397 


Heart— 110 


Chronic 


399 


Diseases of - - 343 


Of the lungs 


377 


Valvular and organ- 


Of the bowels - 


212 


ic diseases of 345 


Of the womb 


647 


Fatty degeneration 


Influenza 


453 


of - 347 


Inertia of the womb - 


617 





INDEX. 


XIII 


PAGE. 




PAGE. 


Innervation 


134 


Meningitis — 




Insolation - 


360 


Tubercular 


370 


Intestines 


114 


Cerebro spinal 


- 373 


Itch - 


533 


Menorrhagia - 


569 






Milk 


- 60 


Kidneys — 


113 


Milk leg 


645 


Inflammation of 


394 


Mode of preparing food 45 






Mortification 


- 471 


Labor — 


609 


Membranes — 


117 


Symptoms of 


610 


Serous 


- 117 


Natural - 


611 


Mucous - 


118 


Positions during - 


614 


Cellular 


- 118 


First stage of. - 


615 


Mumps - 


307 


Second stage of - 


615 


Measles 


- 108 


Third stage of 


617 


Muscles 


- 108 


Lacteal vessels 


115 


Mutton 


52 


Lamb 


56 






Leucorrhea 


575 


Nephritis 


- 394 


Liver — 


112 


Nerves 


119 


Inflammation of 


385 


Neuralgia 


- 426 


Locked jaw - 


511 


Natural symptoms 


of 


Lungs — 


110 


disease - 


- 136 


Inflammation of - 


377 


Nutrition — 


131 


Lunch — 


36 


Functions of 


- 131 


Tavern 


37 


Innervation 


134 


Madness, canine 


457 


Object of medicine 


- 17 


Malarial fever 


156 


Opium eating — 


79 


Manner of eating 


41 


In New York 


- 83 


Management of woman 




By men - 


85 


After labor 


622 


Ophthalmia — 




Management of child 


625 


Catarrhal - 


- 527 


Measles 


319 


Purulent 


529 



XIV 



INDEX 





PAGE. 


PAGE. 


Organs 


- 109 


Puerperal fever — 


632 


Organic disease of 


the 


Is it contagious ? - 


634 


heart 


- 345 


Convulsions in 


627 


Oysters 


58 


Mania 


641 


Pancreas - 


- 113 


Quality of food 


38 


Parotitis 


307 


Quantity of food 


34 


Partaking of food - 


32 






Pelvis 


- 108 


Remittent fever - 


171 


Piles 


439 


Ringworm 


532 


Phthisis 


- 508 


Reproduction 


586 


Phthisis pulmonalis 


517 


Rheumatism— 


259 


Phlegmasia dolens 


- 645 


Gonorrheal 


276 


Pleurisy 


383 


Rheumatoid arthritis 


251 


Pneumonia 


- 377 


Myositis 


270 


Poisoned wounds - 


460 


Roasting food - 


47 


Pork 


- 53 


Rubeola 


319 


Poultry 


57 






Protest in Christian Pio- 


Salted meat - 


56 


neer 


90 


Sausage 


55 


Principles of medicine 127 


Scald head 


533 


Pregnancy — 


590 


Scarlatina - 


299 


Signs of 


- 592 


Scarlet fever — 


299 


Quickening 


594 


Latent 


302 


Treatment of 


- 596 


Scorbutus 


447 


Nausea in 


597 


Scrofula - 


524 


Constipation in 


- 597 


Scurvy 


447 


Diarrhea in 


598 


Shingles - - 


532 


Palpitation of heart 


Skeleton 


106 


in 


- 598 


Skin 


116 


Piles in - 


600 


Snake bite - 


463 


Prolapsus uteri 


- 581 


Small-pox — 


287 


Pure drugs 


556 


Susceptibility 


291 



INDEX. 


XV 


PAGE. PAGE. 


Soups - 59 Turkish bath 


94 


Seat of disease in ner- Two meals a day - 


35 


vous system - 136 




Spleen - - - 113 Ulcerations and Ulcers 


476 


Structural and Func- Ulcers — 


478 


tional disease 124 Acute - 


479 


Stewing food - - 49 Chronic - 


481 


Sting of Insects - 460 Indolent 


483 


Stomach - - - 111 Are due to active in- 


Sunstroke - - 360 flammation - 


481 


Supper 36 




Suppressed Menstrua- Vaccination 


279 


tion - - 561 Yariola - 


287 


Symptoms of disease - 124 Yalvular disease of the 


heart 


345 


Tape 'worm - - 536 Varicella 


310 


Tea, green 67 Veal ... 


55 


" black - - 67 Vegetable diet - 


63 


Table of doses for chil- Veins 


118 


dren - - - 556 Venison - 


53 


Teeth - - 107 




Tiena capitis - - 533 Water - 


66 


Tetanus - - - 511 Wheat 


68 


Tobacco - . - - 88 Whites - 


575 


Tongue 107 Womb 


118 


Treatment of valvular Whooping cough - 


326 


and organic disease of Worms-— 


534 


the heart - - 347 Tape - 


536 


Treatment of heart, lung Symptoms of - 


538 


and brain complica- Treatment - 


539 



tions in rheumatism 267 White Swelling - 494 



THE FAMILY PHYSICIAN 



AND 



GUIDE TO HEALTH. 



THE OBJECT OF MEDICINE. 

Tlie grand object of medicine is to preserve health, 

prolong life, cure disease, and thereby to forward the 

happiness of mankind. Happiness is the great object 

of hnman life; it is the object for which man toils ; all 

his energies are bent in that direction. He racks his brain 

to discover in what direction happiness lies, and when 

he fancies that he can see its faint ontlines in the dim 

and shadowy fntnre, he nerves his energies, straggles on, 

and although obstacles loom up between him and his 

coveted object, he still straggles on, on. But are his 

efforts and labors properly directed ? He has tamed the 

lightning by his efforts, and compels it to convey instant 

intelligence to the most distant and remote points of 

civilization ; he even directs its course through the bosom 

of the ocean, in two great arteries, from this continent to 

Europe. By steam he drives the "iron horse" at the 

terrifying rate of almost lightning speed over hills, 

mountains, plains and valleys, through dark and dreary 

tunnels, and across mighty rivers, in one continued track 

2 



18 THE FAMILY PHYSICIAN 

from the Atlantic to the Pacific ocean, bringing San 
Francisco within one week's journey of New York. But 
this is not all. By its power he runs all manner of 
machinery, from the modern grain thresher to the iron 
mills of Birmingham, and drives the immense floating 
palaces up against the strong current of our great rivers 
and across the raging, briny deep with indescribable 
rapidity, and is the great medium of our national com- 
merce. He even navigates the air with a degree of cer- 
tainty and rapidity that is perfectly marvelous. By his 
intellect he enters the fathomless space of the heavens 
and measures the dimensions and distances of the count- 
less orbs that surround us, while he estimates with frac- 
tional correctness the orbits and the distances traveled 
by the sun, moon and stars, as well as the various laws 
by which those planets are governed ; he traces the comet 
while it performs its stupendous revolutions, and gives 
long in advance the exact time, extent and description 
of an eclipse. He builds his palaces, and makes the 
most complicated machinery to work in perfect order 
and exactness ; while almost every one is a " well-posted" 
politician. They are well posted in this, and in every 
conceivable plan to make money — laboring under the 
great mistake that to be rich is to be happy. Ask the 
millionaire, when he finds that disease has seized upon 
his vitals and he is prostrated in agony upon his couch, 
as the icy fingers of death begin to grapple about his 
heartstrings, what he would give for perfect health, and 
he will tell you, " All, all I have, and ten times as much, 
if I had it." Then his pursuit of happiness has not been 
properly directed. 

You may converse with every man you meet on almost 
every subject that concerns man, and particularly any 
subject that is connected with money-making, and you 



AND GUIDE TO HEALTH. 19 

will find his mind well stored, and he can go into the 
minutest particulars — you would almost take him to be a 
professor. But ask him, if you please, a simple question 
about the laws governing life and health, and his mind, 
in nine cases out of ten, will seem to you to be a blank. 
\Vky is this ? Is it because health is of minor importance 
to mankind ? Certainly not. There is no one so stupid not 
to know better than this ; he knows the objects of his life 
are defeated when his health is lost ; he knows that with 
the loss of health happiness recedes from him forever on 
earth ; he knows that health is the greatest earthly bless- 
ing that he could enjoy ; he knows that without it life is 
but a state of suffering and torment. Then it is not this,, 
and we must look in some other direction for the cause. 
It is a well known fact that physicians have always tried 
to hide their art in the rubbish of technicalities ; how well 
they have succeeded the present ignorance of the common 
people on the subject of medicine furnishes an abundant 
answer. The mass of medical men have always striven 
to impress the minds of the common people with the 
belief that they (the people) were too ignorant to under- 
stand the subject. Every one has heard of priest-ridden 
people, who were deluded into the belief that they were 
too ignorant to pray ; hence it was necessary for them 
(the priests) to do their praying for them, and for which 
they are fully as exorbitant in their charges as are many 
of the medical quacks of the present day. Now, when 
we take into account that money seems to be the grand 
object sought for, it is not to be wondered at that phys- 
icians have striven so hard to keep the common people 
chained in ignorance on this subject ; for really if every 
one understood as much as he ought to, and as much as 
he could understand with very little pains, about the 
laws of life, the current of wealth that has long teemed 



20 THE FAMILY PHYSICIAN 

into the physician's pockets would cease, and man would 
soon begin to live ont his three score years and ten. 

I think I may safely say, without the fear of contra- 
diction, that there has Ibeen practiced upon the people 
more humbuggery in medicine than in anything else. 
And why ? Not because it is of little importance, but 
simply because they were more ignorant of it than any- 
thing else ; and ignorance is the field that humbuggery 
thrives best in. 

A pert son of Esculapius, just out of his teens as well 
as his nosology, blows his trumpet loud and long, and 
announces that he can cure consumption. There is a 
great flutter and much noise, and all who happen to have 
a cough call on the great professor, and for their hard- 
earned money get an ill-advised prescription — written in 
a dead language, which neither they nor the young swell 
understand — which is taken to the druggist, who com- 
pounds it at random, not knowing whether it reads cin- 
namon or ammonia, if we are to credit the account in 
the daily papers, in which there is a case reported where 
an unfortunate individual lost his life by the druggist 
misreading Aq. cinnam. for Aq. amon. The result was, 
the patient got an over-dose of the ammonia and died 
from it. The prescription was : " R. aq. calcis, tine, opii., 
aq. cinnam." Had it been written, " lime water, lauda- 
num and cinnamon," says the IT. Y. Journal of Com- 
merce, "there would have been no room for the fatal 
error." Such cases are of daily occurrence. It does seem 
that it would begin to open the eyes of the people and 
make them clamor for plain English in all medical litera- 
ture ; but instead they only seem to hug the chains that 
have kept them so securely bound. 

But there is another source of humbuggery that has 
assumed gigantic proportions, and is ruining the health 



A^D GUIDE TO HEALTH. 21 

and depleting the pockets of its thousands. Without 
desiring to be severe on patent medicine makers. and 
venders, I feel it my dnty to denounce them as one of the 
great curses of the age — not that all the patent compounds 
are worthless, for some of them may be very excellent 
preparations for certain diseases, or certain stages of 
certain diseases; but in their great anxiety to extend 
the sale of their articles they unhesitatingly and without 
reserve recommend them as " specifics " for almost every 
disease that flesh and blood is heir to. I feel confident 
I have seen a single article thus recommended for twenty 
different diseases, the diseases not even belonging to 
the same class or in any way admitting of the same plan 
of treatment. 

The people, as it would seem, anxious to be humbugged, 
greedily pay out their hard-earned money for these nos- 
trums to torture their stomachs and ultimately destroy 
their constitutions. This they do doubly blind: first, 
they do not know what their diseases are, and, second, 
they do not know what they are taking. This is daily 
done by a people no less intelligent than the people of 
the United States — a people whose minds are cultivated, 
and who are well informed on every subject that is calcu- 
lated to advance their happiness except the very import- 
ant subject of medicine. 

Does not every principle of humanity, mercy and 
philanthropy call for "more light" on the subject of 
domestic medicine ? 

Children, little buds of promise, young men and young 
women just blooming into beauty, middle aged men 
and women who have just ripened into the prime of life, 
are sinking around us daily into premature graves. 
Why is this ? Did the Creator make a mistake in forming 
their organizations ? Do they wear away and fail them 



22 THE FAMILY PHYSICIAN 

before their "three score years and ten" are accom- 
plished? Or is it "because of the violation of certain 
simple laws that God gave them for their government ? 
There can be bat one answer to this : there can be no 
effect without a cause. Man violates a law of health — 
disease follows as the effect, the penalty. Whether this 
law of health has been violated wilfully or ignorantly 
it matters not, the penalty is the same. No allowance is 
made for either ignorance, accident or other circum- 
stances ; the laws are immutable and the penalty sure. 
If a man never violates a law of health he will never be 
sicJc, never. But, says the reader, will he never die ? 
Yes, he will. This stalwart frame, however well devel- 
oped and preserved it may have been by strict attention to 
and observance of the laws of health, must give way 
and succumb to the ravages of time. 

"Time, like an ever-rolling stream, 
Bears all its sons away; 
They fly forgotten, as a dream 
Dies at the opening day." 

It is one of God's laws that all organized creatures 
must decay. But premature decay is a penalty for the 
violation of the laws given for the government of health. 
If man in his strength had a proper knowledge of the 
laws of health and life and would observe them, his 
days would be more happy, and he would live out his 
" three score years and ten." 

"With woman it is a little different. Her organization 
is different, rendering her obnoxious to quite a number of 
diseases that man can not be subject to, and diseases 
that seem to occur almost in the very course of things. 
I do not mean to say that many, very many, of the dis- 
eases that are now, and ever have been, dragging the 
daughters of earth down to premature death can not be 
avoided, for certainly they can ; and I hope in the 



AND GUIDE TO HEALTH. 23 

pages of this book to give such rules and advice as will 
enable all sensible women not only to rid themselves, 
but to steer clear of most of the diseases peculiar to 
their sex. But from the Gakden of Eden the immutable 
decree went forth from Almighty God himself : 

" Unto the woman he said, I will greatly multiply thy 
sorrow and thy conception ; in sorrow thou shalt bring 
forth children ; and thy desire shall be to thy husband, 
and he shall rule over thee." 

"While it is true that women are subject to a wider 
range of diseases than man, it is also true that she is 
endowed with more patience and fortitude, in so much 
that all that can not be avoided can be endured; 
patience and gentleness mark her nature*. 

Now, the object of this work is to give a plain guide to 
health, in language that any ordinary English scholar 
can understand — to make known to the " common 
people" the laws governing life and health, so that 
every one who will may enjoy that priceless boon ; and, 
in addition to this guide, I have tried to lift the veil that 
physicians have so closely tucked around the symptoms 
and treatment of diseases and present them to the fair 
view of every one ; and I state here, frankly, that there 
is nothing about the symptoms and treatment of dis- 
eases that the ordinary mind can not understand. 

When the humbuggery, mystery, technicalities and 
other rubbish is removed from the subject, it will be seen 
to be simple and easy, and every one will be filled with 
wonder that he has so long allowed himself to be hood- 
winked and played upon by the profession. 

The practice that I shall offer is based upon common 
sense and reason. It is to aid and assist nature in her 
efforts to cure diseases ; to sustain the system and not 
to lower it. Sustaining the system is giving life, lower- 



24 THE FAMILY PHYSICIAN 

ing it is taking it away; a destruction of the vital 
powers is death. 

The true plan is : sustain the system, assist nature and 
palliate the symptoms. Trust more to nature and less 
to heroic remedies. The "body possesses a perfectly mar- 
velous power whereby it protects itself and cures dis- 
eases ; it wards off some and cures by its own process 
others. This innate power is called vis naturce medica- 
trix. Of itself it is able to cure numerous diseases ; it 
is in all its influence beneficial ; and the remedies that 
are in their own nature the best are only of use in as far 
as they stimulate, direct and control this inherent virtue. 
Without this curing principle in the human body diseases 
could not be cured ; when the body was prostrated by 
disease all hope would be lost. It would be like a decay 
in a piece of seasoned timber ; the process of decay might 
be stopped for a time, but no application could be made 
or means used to restore it to its original soundness. 
]N"ow, if the system is lowered this power in nature is 
decreased, and by a continued depletory course it is 
finally extinguished and the patient must die. Any 
plan of medication that does not, directly or indirectly, 
sustain or palliate is worse than useless — yea, positively 
injurious. Keep this great principle in mind and you 
can not materially err. Upon this plan, and this plan 
alone, medicine can fulfill the grand object for which it 
was intended, viz : " Preserve health, prolong life, cure 
diseases, and thereby forward the happines of mankind." 

In the prevention or treatment of a disease our science 
culminates and becomes an art. Unless it can accom- 
plish one or the other of these ends the world would do 
as well without as with our aid. It is of some value to 
know the probabilities of our state, but it is of compara- 
tively small value to have this knowledge if we can do 



a:nd guide to health. 25 

nothing either to ward off, alleviate or cure disease. 
"We may prepare some people for the worst, we may 
dispel some groundless fears ; but our mission is to do 
more than this — we have to try to " cure the curable 
and comfort the incurable." 

In the prevention of disease regard is had to the con- 
dition in which the individual is placed, to his hereditary 
or acquired constitutional peculiarities, and to the minute 
physical functions or functional departures from health 
which we may discover. In the treatment of disease no 
one of these can be lost sight of with impunity, but we 
are guided principally by the actual symptoms present 
at the time. These symptoms, however, it must be 
remembered, are of two orders : from the one set we 
learn the actual physical condition of an organ, or a 
group of organs, such as inflammation of a lung, conges- 
tion of the liver, or paralysis of one side of the body ; 
while from the other series we become acquainted with 
the state of the system generally, whether this be ante- 
cedent to the local change, its cause, its effect, or a 
mere coincidence of its existence ; and from such a group 
of symptoms we infer the existence of discrasise, such 
as tuberculosis, carcinoma, or the like, and appreciate 
the presence of vigor, or of asthenia, of sound constitu- 
tion, or of impaired health and wasted strength. 

To the most superficial observer it must be obvious 
that therapeutics has undergone great and important 
changes ; that the mode of treatment now adopted for 
many diseases is just the opposite of that which was in 
vogue a few years ago, and which lingers even in recent 
editions of standard books, although many of their 
authors have long since ceased to follow the directions 
which they still give to others. 

A few years ago the treatment of inflammation of an 



26 THE FAMILY PHYSICIAN 

important organ was laid down definitely : such and such 
tilings were to "be done, and no questions were to "be asked 
as to whether the case was of this, that or the other type. 
Inflammation was there, and blood teas to be taken ; low 
diet was to he enjoined, and lowering medicines were to 
he exhibited; and supposing the inflammation did not 
yield, the forces of attack were to "be again placed in 
action. But here there crept in some distrust of the 
theory evidently at the "bottom of the practice, for, 
instead of general bleeding, leeching or cupping was 
to "be employed, and then only to a mild degree. Some- 
how or other the inflammation was to "be put down ; and 
it not rarely happened that the process urged against the 
bugbear " inflammation " proved fatal or highly injurious 
to the patient. Now we find it written, that if such con- 
ditions are found — a hard, full, strong, frequent pulse, 
with great heat of skin, no prostration, impending evil 
from this condition being patent as the phenomena 
themselves — then bleeding, antiphlogistic s, and the like, 
must be employed. But, as a matter of fact, we do not 
find these cases, and the more common on dit of medical 
practice is to the effect that as the inflammation seemed 
extending, the quantity of wine has to be doubled, the 
supplies of beef tea increased, and bark and ammonia 
given more frequently. Partly to account for and partly 
to justify so material a change in our modes of dealing 
with disease, it has been assumed by some that the vis 
mice 'of the human constitution has undergone a change, 
or has been lessened, or that the so called " type " of its 
maladies have altered— an assumption that has little to 
be said in its defense, and still less than can be regarded 
as its establishment. A more simple and, I believe, 
accurate explanation of the change is to be found in this : 
That previously theory was the ground- work of thera- 



A^D GUIDE TO HEALTH. 27 

peutics, and that now fact is the basis of treatment ; that 
years ago diseases were treated by their names, and 
that now they are treated by their known conditions ; 
that local changes were the main guides in times gone 
by, but that the general state of the patient is that which 
in these days the physician esteems as his therapeutical 
informant. 

"When pathology scarcely existed medical practice was 
an empirical art, and had, with the few advantages of 
that position, all its evils ; whereas, with the growth of 
pathology, therapeutics, still an art, has become, or is 
becoming, a science ; and knowing more accurately the 
limits of its powers is content to attempt less " heroic 
measures," being convinced that it does less harm. 
Much is done by medical treatment now — more real good 
than ever was done before — but it is done in a different 
way and with another aim. Disease is detected in its 
earlier stages and often arrested there, and when devel- 
oped the patient is guided through it, if he can be, and 
is not sacrificed to some wild attempts to destroy the 
disease. 

What we now believe and act upon is no set theory 
regarding the nature of particular diseases, or disease in 
general. Modern times have not been devoid of theories 
upon which the fathers of medicine would justly have 
turned their backs in derision ; but such notions, although 
they may have misguided a few individuals, have soon 
found their proper place, or no place at all, in the science 
of the day. What we believe now and act upon is, a 
better knowledge of the laws and relations of morbid 
change. We see that the man is greater than his maladies ; 
that his general condition is of more importance than his 
local ailments; that disease is a change in him rather 
than in some part of him, and that no treatment can be 



28 THE FAMILY PHYSICIAN 

of any real service which sacrifices the greater to the 
less. In all treatment, therefore, what is general is to 
be dealt with upon the basis of a true appreciation of 
the general pathological condition, and this, in spite of 
all theories in regard to local changes, however they may 
be termed, whether they come to ns hoary with age, or 
scarcely intelligible, and even sometimes ludicrous with 
their novelty. If the general condition be one of weak- 
ness, it matters not that the brain, the heart, or the lungs 
may be in the state of so-called "inflammation," the 
weakness is the one thing that demands immediate 
treatment, and to neglect its treatment is to run the risk 
,of sacrificing the patient to_ a theory of a compound 
state even now but imperfectly understood. 

This is the starting point, the essential -element in 
therapeutics ; but the mode in which the treatment should 
be applied will often be determined by the nature and 
position and origin of the special lesion; and those 
conditions of the latter will direct the management of 
those means and appliances which, employed locally^ 
will prove of service to the injured organ. 



A^s T D GUIDE TO HEALTH. 29 



HEALTH-HYGIENE. 



Health is the greatest blessing man can have vouch- 
safed to him on earth. Its preservation becomes a 
matter, then, of the first importance. This may be accomr 
pushed by obeying its laws. A few of those laws I will 
proceed to give, first noticing a few simple rules of diet. 

Nature delights in the most simple food, and every 
animal, except man, follows her dictates. Man alone 
riots at large, and ransacks the whole creation in quest 
of luxuries, to his own destruction. A clever writer on 
diet speaks thus, " For my part, when I behold a fashion- 
able table set out in all its magnificence I fancy that I 
see gouts and dropsies, fevers and lethargies, with other 
innumerable distempers, lying in ambuscade among 
the dishes." 

Some writers claim that we feed too much, while others 
think we feed too little ; some advocate a strictly vege- 
table diet, and offer as a conclusive argument that man 
in his primeval state of simplicity never ate any animal 
food ; that Adam and Eve, previous to the transgression, 
were not permitted to kill any animal nor partake of 
any meat, as appears by the command of their Maker, 
recorded in the Bible. If we go back to the times of 
King Nebuchadnezzar, spoken of in the Scripture, we 
will find there a triumph over the flesh eating Babylon- 
ians, by the experiment made in the case of four 
children of Judah, who refused the King's meat and drink, 



30 THE FAMILY PHYSICIAN 

and confined themselves simply to their puis and 
water, and yet, for wisdom and fairness of face and 
proportion, none was found like them in all the King's 
realm. 

Porphyry, of Tyre, the Platonist, who flourished 
about the third century, in his Ibook concerning animal 
food, addressed to Firmus Castricus, who had relin- 
quished the Pythagorean system, tells him as follows : 
" You admitted, when you lived among us, that a vege- 
table diet was "better than animal food, both for preserv- 
ing health and to facilitate the study of philosophy ; 
and now, since you have eaten flesh, your own expe- 
rience must convince you that what you then confessed 
was true. It was not from among those who have lived 
on vegetables that robbers and murderers, sycophants 
or tyrants, proceeded, but from flesh eaters." 

You ask me, says Plutarch, "why Pythagoras ab- 
stained from eating the flesh of brutes ? For my part, I 
am astonished to think, on the contrary, what appetite 
induced man to taste of a dead carcass ; or what motive 
could suggest the notion of nourishing himself with the 
flesh of animals which he saw the moment before, bleat- 
ing, bellowing, walking and looking about them." 

In countries where people have lived almost entirely 
upon vegetable diet they have been the most healthy, 
robust, active and cheerful. 

The eating of flesh daily serves to increase the pas- 
sions, subjects the person to numerous diseases, and 
shortens life. This I conceive to be in the abuse of the 
article ; as alcohol, opium, &c, become a curse when used 
too much, in like manner flesh becomes a curse to our 
race. There is a happy medium, however, I think, 
between the advocates of animal diet and vegetable diet 
that we may take to advantage. This consists in the 



AXD GUIDE TO HEALTH. 31 

use of flesh to moderation, not oftener than once a day, 
and that at the dinner meal. I will now proceed to give 
some directions in regard to 

FOOD. 

Dr. John King, in his work offered to the public in 
I860, I believe, entitled the "New American Family 
Physician,-' has given some excellent rules on the sub- 
ject of food, from which I take the liberty to quote: 
" Food or aliment is necessary for the existence of all 
organized beings, but the requisite quantity and quality 
depends very much upon the circumstances connected 
with each individual case. Thus some live entirely 
upon a vegetable diet and enj oy excellent health, while 
with others a portion of animal food is actually neces- 
sary." When I was a young man, says Dr. John King, 
" I followed a strictly vegetable diet for three years, at 
which time I became attacked with a scorbutic disease 
which resisted the various remedies prescribed for its 
removal ; by the advice of an old physician I resumed 
the use of animal food, and the disease left me in a few 
weeks. I have met with many other individuals upon 
whom a strictly vegetable diet exerted similar in- 
fluences." 

GEls T EEAL KULES EOE DIET 

Are all that can be given, each individual must make an 
application of them to himself ; for it will be found that 
many articles viewed and recommended as healthy and 
nutritious will produce with some persons much distress, 
while others can use them with benefit ; that one stomach 
will bear almost any thing with impunity, while with 
another great care must be observed in selecting suitable 
food for it to digest. Hence the necessity of every 
person being thoroughly acquainted with his own pecu- 
liarities in this respect. 



32 THE FAMILY PHYSICIAN 

An author justly remarks: "Almost any common 
food is wholesome to a temperate man who preserves his 
body and his mind in an active, Ibnt not hurried, state ; 
for thus he ventilates and purines his blood, and "brings 
every fibre of his frame into the best condition for the 
proper enjoyment and use of life. It is astonishing how 
much the health is often improved by thinking nothing 
about it, but just going about one's business, and using 
the common means of subsistence, under the guidance 
of common sense and a good conscience. But mere 
ignorance can not do this, and we must be able to con- 
sider before we can reasonably do our duty. Even sav- 
ages have their rules of health, and no one has ever 
reached a hale old age without due attention to exercise, 
air, temperature, rest and diet. Although the dieting of 
soldiers and sailors may prove what is the average 
requirement in respect to food by persons laboriously 
employed, yet this average itself indicates that nature 
is very accommodating or such a variety of constitutions 
could not all be treated in the same manner. Positive 
rules for the direction of appetite are not consistent with 
nature, and every one who possesses reason will ordin- 
arily find a better guide in his own discretion and good 
sense than in any dietary that the doctors can direct." 

In partaking of food much will depend upon the 
appetite ; if this be healthy or natural, a proper amount 
of aliment will refresh and invigorate the system ; if it 
be artificial, that is, excited by stimulants of various' 
kinds, not only will the stomach be seriously injured, 
but irreparable mischief will frequently be done to the 
system. Some persons form an appetite of habit, that is, 
accustoming themselves to eat at certain hours, whether 
the food is required or not, and often without any 
relish for it ; such individuals, as well as those who take 



AXD GUIDE TO HEALTH. 33 

food without an appetite, are very apt to be complaining 
that " food does not seem to do them any good," as well 
as to be laboring under a host of disagreeable symptoms, 
which speedily destroy health and life. 

Food taken into the stomach from an artificial appetite 
is always imperfectly digested, and must, as an inevitable 
consequence, produce diarrhea, if such a course is per- 
sisted in ; for as soon as the influence of the stimulus 
has passed the stomach returns to its original torpid 
condition, and instead of the food being digested, it 
decomposes and putrifles, and passes out of the stomach 
in a condition to create disease and shorten life. I have 
observed among my own acquaintances that of those 
who were in the habit of provoking their appetites by 
stimulants the great majority did not live to see the 
prime of manhood, and I have no doubt but this will be 
found to be true generally. When an individual has no 
desire for food it is always better not to eat, because an 
abstinence for a certain period, if not of too long dura- 
tion, will cause a return of the natural appetite; yet 
invalids who have no appetite frequently eat, not that 
they desire food, but because it is the regular hour for 
meals, and in this manner they perpetuate the want of 
appetite and increase the severity and obstinacy of their 
afflictions. It is much better to pass one, two, or even 
twelve meals than to injure the stomach, and conse- 
quently the whole system, by forcing food into it when 
it is neither craved nor relished. Occasionally the 
functions of the digestive organs may become so torpid 
that the mere abstinence from food will not restore them 
to a healthful activity, and should the person wait for 
a return of his appetite serious and permanent mischief 
might be the consequence. However, in nearly all such 

cases an attention to the functions of the skin and to exer- 
3 



34 THE FAMILY PHYSICIAN" 

cise in the open air, with regularity in sleep and proper 
medication, will arouse a sufficient degree of digestive 
energy for the purposes of animal existence, and which, 
when developed, may "be still further improved by a care- 
ful observance of the quality and quantity of the food, as 
well as of its proper mastication. Very rarely, indeed, 
is it necessary to provoke an appetite by stimulating the 
coats of the stomach to a transitory activity, and he who 
is guilty of such a transgression must not expect to live 
half of his days. 

THE QUANTITY OF FOOD TO BE TAKEN AT A MEAL 

Depends entirely upon circumstances ; generally indi- 
viduals eat nearly twice as much as is necessary for the 
requirements of the system. Laboring persons require 
more food than those of sedentary professions. But this 
must be regulated by the age, the amount of exercise, 
the wear and tear of the body, and the character of the 
climate, as well as by the composition and digestibility 
of the food. 

On an average, a healthy adult, in a temperate climate, 
who takes moderate exercise daily, may use from twenty- 
five to thirty-five ounces of solid food per day; if the 
temperature of his location is considerably elevated, 
much less will suffice ; and if it be considerably dimin- 
ished, more will be required. As a general rule, the 
proper quantity of food to be taken at one meal can be 
better determined by the feelings of the person than by 
any specific formula, provided it be eaten slowly and with 
due attention to its thorough mastication. By this I do 
not mean that individuals should abuse their stomachs 
and eat to satiety, as this is extremely improper and 
unhealthy, but that when a sensation of ease, satisfaction 
and mental and physical quietude is felt, enough has 



AND GUIDE TO HEALTH. 35 

been received into the stomach. It were generally better 
for all persons to rise from the table with an appetite, 
having eaten jnst sufficient to avoid a definite feeling of 
satisfaction ; and the necessary quantity may be ascer- 
tained in a short time by each one observing for several 
meals what amount of food it requires to produce the 
above named effect in his particular case. The same 
rule holds good with patients laboring nnder chronic 
disease, but without loss of appetite. Fever patients, 
and others whose appetites are diminished, should never 
eat largely nor produce an artificial appetite by any 
means whatever. It may at first be a severe tax to 
rise from the table not fully satisfied with what has 
been eaten, but custom will soon make it easy; and 
whoever pursues this course will be fully repaid for his 
forbearance by a freedom from those discomforts and 
unpleasant sensations so frequently following the full 
indulgence of the appetite. 



With a moderate refreshment between, are sufficient for 
health ; but they never should exceed three. 



As a general rule, should be taken soon after rising and 
dressing, except in those cases where an early breakfast 
disagrees and where active exercise before the morning 
meal appears to benefit the individual. 

Children are frequently injured by working them or 
sending them to school before they have eaten breakfast ; 
and the danger of infection from contagious disorders, 
epidemic causes, &c, is greatly enhanced by an exposure 
to their influence before breakfast. This should be of 
vegetables entirely, using no animal diet at all, and, 



36 THE FAMILY PHYSICIAN 

generally speaking, it may "be a full, healthy meal, more 
particularly among laboring people. 

THE DINNER 

Should Ibe taken about six hours after breakfast, though 
many persons who eat only two meals per day enjoy 
excellent health by having an interval of eight or ten 
hours between them. The stomach can easily be made 
to adapt its wants in this respect to any reasonable 
length of intervals by attention and cultivation for a 
few weeks. With hard working men the dinner may be 
composed of an equal amount of vegetable and animal 
food, while with the sedentary animal diet should be 
eaten sparingly, and only once or twice a week. A 
moderate amount of fish, soft boiled eggs, or oysters, 
may be substituted for the animal diet with benefit in 
all cases where they agree with the system. This meal, 
with a hard working person, should be a full one. 

SUPPER 

Is generally an unnecessary meal, and those who can 
dispense with it will find it an advantage to health and 
to refreshing sleep. Yet those who dine very early, or 
who exercise actively, may find it necessary to take a 
light vegetable meal at the close of the day, in order to 
allay hunger and dispose to sleep. Supper should be 
light, and ought always to be taken two or three hours 
before retiring for the night, otherwise it will be very apt 
to prevent sleep, or occasion unrefreshing sleep, accom- 
panied with disagreeable dreams. 

THE HABIT OF TAKING A LUNCH OE LUNCHEON 

Between meals is a most pernicious one, particularly to 
persons not engaged in active exercise. However, the 



AJfD GUIDE TO HEALTH. 37 

most sedentary sometimes experience a desire for food 
between their ordinary meals, occasioned frequently by 
a little more exercise than is usual with them ; laboring 
people may also require a lunch, especially when extra- 
ordinary labor and the depressing influence of heat 
produce a sense of fatigue or debility with hunger. In 
all these cases the use of ripe fruits will be found more 
beneficial than any other article that can be used, But 
no person should provoke an appetite of habit for any 
species of food by eating between meals when the stomach 
does not call for it, because, if persisted in, it will give 
rise to some form of disease. 



Assisted as it usually is by one or more draughts of 
intoxicating liquors, is a most dangerous custom, being 
equally destructive to both the physical and moral health 
of those who engage in it. 

Although it is utterly impossible to sustain life upon 
any single alimentary substance, no matter how nutritive 
it may be, it is by no means proper that a great variety 
of food should be taken at one meal. Such a course 
interferes with the function of digestion, and will ulti- 
mately give rise to disease. The fewer the articles of 
diet used at any meal the better will it be for the health 
of the persons and the normal condition of the stomach. 
An excess of food at any time causes giddiness, lassitude, 
uneasiness, distention of the stomach and drowsiness, 
and if persisted in will ultimately destroy health and 
life. And when a person experiences any of these sensa- 
tions he is thereby warned that he has eaten too much. 
Those who are disposed to apoplexy should eat a nour- 
ishing, digestible diet, but always in moderation, and on 
no account should they permit themselves to sleep soon 



38 THE FAMILY PHYSICIAN 

after a meal, particularly if it lias been a full one, on 
account of the tendency at this time to an attack of the 

disease. 

THE QUALITY OF THE FOOD 

Is a very important consideration. Man is undoubtedly 
an omnivorous animal, and requires both animal and 
vegetable food, the first of which yields a much larger 
amount of nourishment than the latter ; but it must not 
be forgotten that a too highly nutritive diet is as detri- 
mental to health and longevity as that which contains an 
insufficient quantity of nutriment. Consequently it is 
better to use animal diet in proportion to the quantity of 
vegetables which is consumed, according to the require- 
ments of the constitution. 

Vegetables require a longer period for digestion than 
animal food, and are, likewise, more apt to produce 
acidity and flatulency ; those, however, which are cooked 
usually digest the more readily, though in this form they 
are not always adapted to the nutrition of the system, 
from the fact that the application of heat more or less 
completely destroys their organization. Animal food 
digests more readily than vegetable; and, though the 
flesh of young animals is more tender and soluble than 
that of the adult animal, yet it is frequently less diges- 
tible. For instance, it is well known that beef and 
mutton are more readily digested and are more health- 
ful than veal and lamb. Yet vegetable diet affords as 
much nourishment to the system as animal, and without 
occasioning as much stimulation, heat, or repletion of 
the blood vessels ; and, as a general rule, those who use 
animal food sparingly have a better appearance, more 
strength and more cheerful spirits than those who par- 
take largely of it; their muscles are, likewise, firmer 
and more plump, and their skin more clear and free from 



A^D GUIDE TO HEALTH. 39 

disease. Animal diet increases the action of the heart 
and arteries during digestion, renders the "blood thicker, 
richer, and more stimulating, and causes a greater ten- 
dency to inflammatory and other forms of disease, than 
one of a vegetable character. 

In relation to the kind of food best adapted for use, 
each individual should observe what articles agree best 
with his stomach, for it is frequently the case that an 
article which would be perfectly proper and quite health- 
ful for one class of persons would produce much 
derangement in others. Again, the inhabitants of one 
climate will, on account of the excessive heat or cold, 
require directly opposite kinds of food to maintain 
health and support life. Thus, the natives of Greenland 
could not exist unless they largely used oil and fat 
meats, which cause a large quantity of carbon to be 
formed in the system, and the combustion of which, by 
the oxygen of the air, produces a great degree of heat, 
sufficient to enable the system to resist the intense cold- 
ness of their climate. Again, in tropical climates, and in 
temperate latitudes during the hot season, the system 
requires a smaller quantity of food, and of less carbon- 
aceous quality, because the air being expanded less 
oxygen is inhaled at each inspiration than in cold 
climates ; and when the inhabitants of warm countries 
consume large quantities of food an excess of carbon- 
aceous matter is produced in the system, which not being- 
destroyed by the oxygen of the air, engenders disease 
of the liver, bilious fevers, &c. On the contrary, a defi- 
ciency of carbonaceous food in cold countries, or in cold 
seasons, when there is an excess of oxygen, diminishes 
the animal temperature and gives rise to pulmonic 
diseases. 

There is one thing, however, which I may state here, 



40 THE FAMILY PHYSICIAN 

and that is, that many vegetables are rich in carbon, 
containing it, probably, more largely than animal flesh ; 
and, no doubt, a diet from such vegetables would be 
more beneficial to even those residing in cold countries 
than the excess of animal food so commonly used. 
Intellectual activity is very much diminished by an 
excessive use of flesh, while, on the contrary, those who 
eat sparingly of it, have a greater degree of intellectual 
and moral power. This fact may be readily ascertained 
by comparing meat-eating nations with those whose fare 
is principally derived from the vegetable kingdom. 

CHILDKEN EEQUIEE LESS ANIMAL FOOD. 

Children require much less animal food than adults, 
and females than males, and whatever may be the custom 
or business of an individual, the quantity of animal 
food should be greatly diminished in warm weather; 
indeed, for the sedentary, and those of full habit, it were 
better to eschew meat entirely during the hot months of 
the year. In cold weather a more stimulating and per- 
sistent nourishment is needed than in summer, and a 
certain amount of animal food will generally be of 
benefit, more especially to those of active laboring habits. 

There is no doubt but an excess of animal diet vitiates 
the fluids of the system ; and you most commonly find 
that those who are laboring under "humors," as scro- 
fula, cancer, cutaneous diseases, &c, are either great- 
flesh eaters themselves, or their immediate predecessors 
were. Animals are as liable to disease as human beings, 
and however apparently pure their flesh may be, a 
tendency to disease is imparted to those who consume 
it. But when the animal itself is diseased, by the perni- 
cious habit of stall feeding to fit it for our markets, or 
by a forced driving from country pastures, the deleterious 



AND GUIDE TO HEALTH. 41 

consequences arising from the use of their flesh as food 
must be, as it is evident to every discerning mind, of a 
serious character. Large flesh-eaters, and especially 
those in country places where pork in some form is eaten 
at every meal, are very liable to epidemic and malignant 
diseases ; and thousands have died of typhoid, bilious 
and congestive fevers, of dysentery, of cholera, small 
pox, &c., who might have been saved if their systems 
had not been vitiated by the gross character of their 
food. Among children, those who are the greatest flesh- 
eaters are subject to worms, diarrhea, &c. 

CONDIMENTS 

Should generally be avoided, because they generally 
over- stimulate the stomach, causing an artificial demand 
for more food than is necessary, and a repetition of 
which must ultimately weaken, if not actually disease, 
that organ. The plainer and simpler the diet the greater 
will be the mental and physical health and strength. 
Hence persons who are constantly indulging in high- 
seasoned food, rich puddings and pastry, mince pies, 
plum puddings, plum cake, hot bread, &c, are as con- 
stantly suffering from some kind of affliction, for which 
they are obliged to be almost constantly under the physi- 
cian's care. It is not necessary, however, that food 
should be unpalatable, because if this be the case the 
stomach will refuse it ; it should be plain, nutritious 
and palatable, and sufficient should be eaten to prevent 
the system from becoming debilitated. In speaking of 
the various articles of diet separately, a few pages 
beyond, further reference will be made to the above 
points. 

THE MANNER OF EATING 

Is by no means a trifling consideration ; it is as important 



42 THE FAMILY PHYSICIAN" 

to health and proper digestion as attention to the 
quantity and quality of the food. But to witness the 
major portion of American meals, and especially at 
public places, one would suppose that it was a matter of 
no interest how food was eaten so it became safely 
lodged in the stomach. A stranger to the habits of this 
country, on witnessing a meal on a steamboat or at a 
hotel, would be led to believe either that the partakers 
thereof were eating on a wager, and that the first one 
from the table would be winner, or that the meal was so 
obnoxious a task that every one endeavored to hasten 
through it as rapidly as possible, pouring soup, fish, 
meats, custards, pies, liquor, nuts, oranges, raisins, &c, 
into the stomach en masse, without regard to quantity 
or their preparation for the digestive organs. ISTo wonder 
that headaches, dyspepsia, consumption, hepatic affec- 
tions and premature old age are so common among us ; 
and especially when we consider that the destructive 
influence of such a course are most generally aided by a 
want of exercise, various dissipations, &c. 

For at least half an hour previous to a meal, and an 
hour after, more especially with the dinner, our principal 
meal, active bodily and mental exercise should be 
avoided as much as possible ; thus, running, long and 
hurried walking, protracted speaking or singing, serious 
or active study or thought, &c, are exceedingly impro- 
per at such times. The individual should endeavor to 
compose his system, and thus prepare his stomach for 
the meal, and maintain this state of quietude for about 
an hour after finishing the meal, in order not to interfere 
with the digestive action. Such a course will permit the 
stomach to properly digest the food, prevent disease, 
impart strength and nourishment, and entirely obviate a 
tendency to dyspepsia. 



AND GUIDE TO HEALTH. , 43 

DURING A MEAL 

Little or no fluid should be drank, as it distends the 
stomach, dilutes the gastric juice, impairing its digestive 
solvency, and thereby increasing a disposition to gastric 
affections. Observe animals in this respect — they never 
eat and drink at the same time. When drink is taken 
during or soon after a meal it should not be too cold 
nor too hot, but moderately warm ; because, heat being 
necessary to digestion, the cold beverage arrests the 
digestive process, causes the food to remain undigested 
in the stomach, often for several hours, thus producing 
dyspepsia, obstructions, &c; and if the drink be too hot, 
the stomach is too much stimulated, from which reaction 
takes place, resulting in debility and loss of action of the 
organs concerned in the functions of digestion. 

POWEEFUL MENTAL EXCITEMENT 

Should be avoided immediately previous to, during, or 
for some time after a meal, especially anger. Many a 
person disposed to apoplexy, epilepsy, or other form of 
disease, has brought on a fatal attack by eating imme- 
diately after some intense excitement of the mind, and 
even by becoming angry after a temperate meal. Sexual 
cohabitation after a meal is frequently indulged in ; this 
is exceedingly pernicious, and though in the young adult 
it may be practiced with impunity, \% will certainly 
and invariably give rise to some permanent and serious 
disease if persisted in. 

A meal should always be made a mental and 
physical relaxation instead of the gloomy, melancholy 
and hurriedly anxious appearance of our mysteriously 
taciturn eaters, who at a meal resemble criminals 
instead of honest, intelligent individuals. Cheerfulness 
and sociability should prevail ; conversation of a light, 



44 THE FAMILY PHYSICIAN 

interesting character should Ibe indulged in, so that all, 
even to children, at the table may participate. The 
meal should be consumed leisurely, without hurry or 
any unpleasant, constrained feelings, each one endeavor- 
ing to render his neighbors happy and cheerful, and thus 
secure these same feelings for himself. At least half an 
hour should be devoted to a meal. Money-worshipers 
may despise this remark, but the day for regret and 
suffering from an inattention to these rules is certain to 
come. Let all who value health and happiness be strictly 
observant in these matters. How many are there who 
have gained riches at the expense of health, and instead 
of enjoying their possessions are rapidly parting with 
them to the physician, &c, in the vain endeavor to regain 
former health and strength ? To destroy the constitution 
in the desire to amass a fortune, and then to dispense 
with this fortune that the system may be restored to its 
former condition, seems to me folly in the extreme. A 
life so passed is truly a mis-spent one. 

FOOD MUST ALWAYS BE WELL MASTICATED 

Before it is swallowed, the finer the better; and the act 
of chewing or masticating, instead of being rapid, as is 
too often the case, should be performed with care and 
moderation, taking ample time to perfect the complete 
mastication of the food, thereby inviting a flow of saliva 
to the mouth, which, by mixing with the food, assists in 
its thorough digestion in the stomach, and, at the same 
time, prevents us from putting into the stomach more 
food than is really required for health. Fast eaters 
seldom masticate their food sufficiently, hence they not 
only throw into the stomach a quantity of solid matter 
not fitted and prepared for the digestive powers, but 
from the rapidity with which it is " bolted down " the 



AND GUIDE TO HEALTH. 45 

stoma cli does not begin to fully realize its presence until 
too much lias been received into it, and dyspepsia must 
undoubtedly be the result. 

Parents are inflicting a serious injury upon their 
children by urging them to eat fast. Indeed, a great 
part of the dyspepsia of adult age may be traced to the 
endeavor of the child to obey that too frequently repeated 
command, "Make haste, eat faster; I am in a hurry, 
and don't want the table to stand here all day." 

MODE OF PEEPAEATION OF FOOD. 

Those articles of food, such, for instance, as meats, amy- 
laceous substances, &c, which are not eaten until cooked 
are generally prepared to suit the taste of persons either 
by boiling, roasting, broiling, baking, stewing or frying ; 
and as there is an essential difference in the digestibility 
and nutritive character of the same article when differ- 
ently prepared, a few remarks on the several modes of 
cooking will be proper. 

The preparation of food demands as much attention 
as its selection, because the most nutritious and 
appropriate articles may be rendered innutritions and 
indigestible by an improper method of cooking. Food 
should not be decomposed by cooking, but merely dis- 
integrated, so as to facilitate its decomposition and 
digestion in the stomach ; too much or too long-continued 
heat decomposes animal substances, impairs their nutri- 
tive principles and renders them unfit for diet. So also 
does the preservation of them by artificial means, as 
salting, smoking and pickling; either of these means 
tend more or less to impair the digestibility of animal 
flesh, by increasing the hardness of its texture and com- 
bining with it some foreign substance which can not be 
separated from it in cooking. Perhaps the best and 



46 THE FAMILY PHYSICIAN 

least objectionable mode of preserving fish, meat and 
fruit is "by sugar. It has the advantage over salt in not 
rendering meat less savory nor less nutritive, and in pre- 
venting putrefaction with a much smaller quantity. 
Pyroligenous acid is likewise an useful preventive. 
Meat and fish dipped in it for a few minutes may be 
preserved for months without having their virtues injured 
and without being attacked by insects. When this acid 
is used the substances should be confined, so as to pre- 
vent evaporation, otherwise, if exposed for a length of 
time in the open air, the acid evaporates and decomposi- 
tion ensues from the action of the atmosphere. 

BOILING 

Is probably the most eligible mode of cooking ; it softens 
the animal fiber, renders it more pulpy, and thus enables 
it to be more readily and effectually acted upon by the 
juices of the stomach. It undoubtedly decomposes some 
parts of the meat, depriving it of a portion of its nutri- 
tive properties, solidifying the albumen and changing 
the gelatin into a glutinous matter ; but still it does not 
alter the relation of the elements in meat as to materially 
diminish its nutritious qualities. Much, however, de- 
pends on the manner in which the process is conducted : 
if the boiling be too quick, the albuminous matter of the 
meat is coagulated, the outside of the flesh is rendered 
hard, while the interior is not sufficiently done, and the 
digestibility of the meat is much diminished. If the 
boiling be too slow or too long- continued, a hard and 
indigestible substance may be obtained; or if this be 
not the case, the nutritive quality of the meat will be 
considerably lessened. The best method of boiling meat 
so as to preserve its juices, secure its tenderness and not 
materially diminish its nutrient qualities, is to first boil 



AXD GUIDE TO HEALTH. 47 

the water briskly, then introduce the meat, continue the 
boiling for a few minutes and then diminish the tempera- 
ture of the water to 168 ° or 170 ° by adding sufficient 
cold water, so as to keep the fluid in that state which 
approaches more to simmering than boiling, at which 
temperature it may be kept for two or three hours. In 
this way all meat, except poultry, should be prepared 
for invalids and dyspeptics. 

Beef, mutton and other matured animal meats are 
always more tender and juicy when boiled in hard 
water, because a layer of coagulated albumen is more 
readily produced on their surfaces, preventing the escape 
of their juices. On the contrary, fish should always be 
boiled in soft water, as their firmness and consequent 
indigestibility is proportioned to the hardness of the 
water. Soups, broths and jellies require soft water. 

BOILING DISSOLVES THE CELL WALLS 

Of vegetable substances, deprives them of a quantity of 
air, and renders them more soluble in the stomach. Long 
simmering is preferable to boiling, so that they may be 
perfectly softened throughout, but in no part quite dis- 
solved. Rain or soft water, with a little salt, is better 
adapted to vegetables, such as potatoes, cabbage, greens, 
corn, turnips, cauliflower, peas, &c, and these always 
require a long boiling, because they are rendered indi- 
gestible and highly injurious when boiled too little. 
Potatoes are most nutritious and digestible when boiled 
so as to be neither waxy nor mealy, but so softened as 
to be readily mashed. Over-boiling lessens their nutri- 
tive quality. 

BOASTING IS THE NEXT BEST 

Method of cooking. By this process flesh is deprived of 
part of its water, its fat is liquefied, partially escaping, 



48 THE FAMILY PHYSICIAN 

its albumen is coagulated and its fibrin corrugated. As 
the roasting proceeds the surface of the substance acted 
upon becomes gradually darker colored, and finally 
scorched, and its tendinous portions are rendered viscid 
and tender. Meats when roasted should- not be under- 
done nor overdone. The popular idea is that when 
underdone they are more nourishing, but this is an error ; 
besides, underdone roasted meats are less digestible and 
consequently less nutritious than when well done. Boil- 
ing extracts the gelatin of flesh, while roasting does not. 
By boiling beef loses one-fourth of its weight and mutton 
one-fifth, but by roasting they lose one-third. The starch 
grains of vegetables are rendered more or less soluble 
by roasting, and thus many of them are rendered more 
digestible and nutritive than they would be in a raw 
state. Vegetable albumen is coagulated by roasting. 

BROILING 

Produces changes in meat similar to those caused by 
roasting, but the process is more rapid. The outside sur- 
face becomes suddenly brown or hardened, preventing the 
internal juices from evaporating, so that the meat is 
rendered peculiarly tender and more savory than when 
roasted. For dyspeptics and those of delicate stomachs 
broiled meats are not as well fitted as when boiled. 

BAKING, 

When mismanaged and not attended to, is a very 
objectionable mode of cooking meats, and has, probably, 
from this cause created some prejudice against it ; but 
when properly managed it is the most economical, the 
least troublesome and the most useful method of preparing 
nearly every kind of food. Most usually too much heat 
is employed, which decomposes the fat and produces a 
disagreeable and injurious empyreuma, which renders 



AND GUIDE TO HEALTH. 49 

the meat unpalatable and indigestible. But if the heat 
be properly regulated, and especially if the substance 
baking be slightly covered so as to prevent scorching and 
drying, the meat will be rendered tender and juicy, of 
the flavor of roast, having its nutritious particles pre- 
served, and without any decomposition and waste. 
Baked meat pies, and particularly when the pastry is 
rich with butter, are more difficult of digestion than 
meat baked without any pastry. Dyspeptics, and those 
whose stomachs are weak, should avoid all baked food, 
except it be light, amylaceous puddings, made of arrow 
root, sago, tapioca, rice, &c. 

STEWING IS OBJECTIONABLE. 

It deprives the meat of much of its juices, and decom- 
poses, in a greater or less degree, the fatty and gelatinous 
portions. 

The fluid in which meat is stewed contains a great 
part of its nutritious elements, but, being too fluid, they 
can not be digested until their watery parts have been 
absorbed by the stomach. Stews are not adapted as 
food for the sedentary and dyspeptic, and if they be 
habitually partaken of they will eventually produce pain- 
ful and dangerous symptoms of disease. They are ren- 
dered still more indigestible and unfit for the stomach 
when various spices, butter, wine, or other stimulating 
ingredients, are added to improve their flavor. 

FRYING IS THE MOST OBJECTIONABLE 

Of all the modes of cooking. The heat is applied to the 
meat through the medium of boiling fat or oil, which is 
rendered extremely indigestible and objectionable to the 
stomach on account of the chemical changes which are 
thereby effected. Invalids, convalescents and dyspeptics 
should never eat fries, as eggs, oysters, pancakes, 
omelettes, fritters, fried fish, liver, pork, beef, mutton, &c. 



50 THE FAMILY PHYSICIAN 



ARTICLES OF ANIMAL DIET. 



MEATS, POULTRY, FISH, EGGS, MILK, BUTTER. 

The articles from wliicli food is prepared are various, 
whether derived from the animal or vegetable kingdom, 
and as some of them are preferable to others on account 
of their being more readily digested and their different 
nutritive powers, a brief reference to them will be 
necessary. I will commence with those from the animal 
kingdom, first observing that dark colored meat is 
usually more digestible and nourishing than the white 
meat of animals, on account of its containing a greater 
amount of fibrin ; and the same may be said of the flesh 
of animals which are permitted to roam unrestrainedly 
in the open air when compared with that of stall-fed 
beasts. Again, the meat of hunted animals is tenderer 
and more digestible than those which are killed without 
any previous exercise. The flesh of the female animal 
is almost always more savory than that of the male, 
while that of a castrated or spayed animal is still more 
so. All meats have their digestibility as well as nutrient 
qualities impaired by salting and smoking. Hence, 
although salted meats may be eaten by healthy persons 
of active habits, yet, as a general rule, they are unfit for 
convalescents, dyspeptics, and those of sedentary occu- 
pations. 

BEEF 

Is a very healthy, nutritious and easily digested meat ; 
it should be soft, pliable, fat, and taken from an animal 



AND GUIDE TO HEALTH. 51 

neither too young nor too old, and perfectly free from 
disease. Its fat part is not so easily digested as its lean ; 
hence the great accumulation of fat upon prize beef does 
not contribute any to its value, though nnless some fat 
be present the lean part is not so apt to be juicy and 
tender. The tongue, as well as the tripe, are not so easily 
digested as other parts, and are, therefore, not proper 
food for dyspeptics and those having weak stomachs. 
Properly corn-fed animals, that have had plenty of 
exercise in the open air, furnish the most healthy and 
delicious meat. 

The best mode of cooking beef is by boiling or roast- 
ing, though beefsteaks are by no means indigestible 
when properly managed. To be wholesome beef must 
not be too much done nor underdone. As an article of 
diet for convalescent persons, it is best prepared in the 
form of beef tea, which should be made as follows : Cut 
half a pound of the lean part of a good rump steak into 
thin slices, put these in a dish, sprinkle a little salt over 
them, and pour on them a pint of boiling water, cover 
the dish with a plate, and set it over a very gentle fire, 
that it may steep, not boil, for an hour ; then put the 
whole into a pan, cover it, and allow it to boil for fifteen 
minutes ; after which strain off the fluid from the meat 
through a fine seive or napkin. If this tea be too strong, 
it can be reduced by the addition of boiling water. 

Generally the firmer texture of beef renders it less 
readily digested than mutton, on which account this 
latter is the preferable meat for convalescents. 

DRIED OR SMOKED BEEF 

Forms a palatable and wholesome relish for healthy 
stomachs, but the meat having been impaired in its 
digestibility by drying, salting and smoking, it is not 
adapted to the weakly and dyspeptic. 



52 THE FAMILY PHYSICIAN 

The density of fibre of every kind of animal food is 
very much lessened by keeping it for a certain length of 
time before cooking, which is owing to an incipient 
decomposition having ensued ; but great care should be 
taken not to allow this process to advance so far as to 
taint the meat in the slightest degree, for it would be 
very apt to give rise to disease or, in convalescents, 
cause a relapse. 

MUTTON 

Is probably more easily digested than any other animal 
food, being at the same time highly nourishing and 
healthy. The flesh of the castrated animal, or wether 
mutton, is by far more palatable and more digestible 
than that of the male animal ; this last is coarse, and so 
unsavory that many persons can not eat it at all. Ewe 
mutton is also preferable to the male, if the animal is 
not above three years old. For convalescents, dyspep- 
tics and persons of weak stomachs, there is no meat so 
wholesome and digestible as wether mutton : it is best 
cooked by boiling. A mutton tea may be prepared for 
invalids as follows : Cut half a pound of the lean part 
of good mutton into thin slices, put these into a dish, 
with a pint of boiling, soft water, cover the dish with a 
plate and set it over a very gentle fire, that it may steep 
for an hour ; then put the whole into a pan, cover it, and 
allow it to boil for half an hour ; after which strain off 
the fluid through a fine seive or napkin. If it is desired 
to add barley to this, an ounce of pearl barley, pre- 
viously washed and macerated in boiling water for an 
hour, may be boiled with the mutton tea — separating 
the barley by straining. From the tendency of sheep to 
disease, care must be taken never to eat the meat of a 
diseased animal. 



AJD GUIDE TO HEALTH. 53 

VENISON 

Is a nourishing, palatable, liealtliful and easily digested 
meat, and from the fact that the deer is usually killed in 
chase its flesh, like most varieties of game, is more ten- 
der than that of the domestic animals killed in the 
ordinary way, and by some is considered a greater deli- 
cacy. 

POEK 

Is usually considered a savory, nutritious meat ; not so 
digestible, however, nor even so healthful as beef or 
mutton. I consider it a very unwholesome meat, not- 
withstanding its extensive preparation and use in this 
country, because, in adition to its greater indigestibility, 
it is almost always diseased. There is hardly a hog 
fattened for the market but what labors under a measly 
condition, or a tuberculous affection of the liver or kid- 
neys, or perhaps both, as well as of other organs ; and it 
is no uncommon thing for people eating pork to cut or 
bite into hardened tubercles in various parts of the lean 
and especially of the fat of the meat. Surely the meat 
of a diseased animal can not be healthy, and yet this 
diseased meat forms the principal part of the diet of an 
immense portion of our population. No wonder that 
diseases of the skin, scrofula, cancer, disordered diges- 
tive organs, &c, are so common in those sections of the 
country where it is so constantly eaten, or that epidemics, 
as dysenteries, typhoid fevers, &c, prove so fatal, when 
they occur among a class of people whose principal 
diet is pork in some form, but more generally that of 
bacon. I have seen persons cut into a piece of pork 
containing tubercles and actually eat it, even after having 
been told it was diseased, so great was their reverence 
for pork. I have no doubt but that with many persons 



54 THE FAMILY PHYSICIAN 

the use- of whisky, peach brandy, apple "brandy or other 
alcoholic drinks lessens the immediate effects of the 
influence of pork upon their systems, for it is a well 
ascertained fact that these liquors will prevent or suspend 
the activity of tuberculous affections for a long time? 
frequently effecting apparent cures. But then the remedy 
is by far a greater evil than the pork eating; it were 
much better to use neither. Bestow the same attention 
upon raising beef and mutton and it will give better 
results, both as regards health and pecuniary profit. 

Even when the flesh of pork is healthy it is not so 
wholesome and digestible as other meats, being better 
adapted to those whose stomachs are healthy and strong 
and whose occupations are active and laborious ; and in 
all cases its long continued use will invariably give rise 
to disease sooner or later in life. And as many will con- 
tinue to use it, notwithstanding its unwholesomeness, a 
few remarks may be made in reference to its several 
modes of preparation. Pork should never be eaten by 
dyspeptics, by those of sedentary habits, nor by those 
inclined to corpulency or who are liable to affections of the 
skin, scrofula or other tuberculous forms of disease. 
The flesh of the sucking pig or shoat is considered a 
dainty relish by some, but it is much less digestible than 
the matured meat, and frequently affects the bowels in a 
violent manner. 

BACOIST. 

\Vken the sides and flanks of a full grown hog are 
salted and dried (and freqently smoked), it is called 
bacon. It is a strong, exciting article of food, hard to 
digest and fit only for robust persons who work hard. 
The best method of cooking it is to boil with vegetables ; 
when fried, with or without eggs, it is unhealthy and not 
fit to eat. 



AND GUIDE TO HEALTH. 55 

\YTieii the thigh or ham of the hog is salted and 
smoked it forms 7iam, a stimulating food fit only for 
laborious persons, and which, on account of its difficult 
digestibility, frequently disagrees with many. It proves 
wholesome only to those with whom it agrees. It is best 
cooked by boiling ; when fried it is rendered very indi- 
gestible, and should not be eaten by dyspeptics and per- 
sons of sedentary occupations. 

SAUSAGES 

May be prepared from the boiled flesh of several animals — 
in this country they are principally made from pork. 
The meat is made fine, seasoned with salt, pepper and 
spices, and is eaten in that state, or more commonly dried 
and smoked. They are a very indigestible article of diet, 
being scarcely fit for the stomach of the robust and hardy, 
and they should be especially rejected by the sedentary 
and dyspeptic. "When exposed for any length of time 
to dampness they are liable to experience certain chemi- 
cal changes which render them poisonous. 

The name scrofula had its origin in the well known 
fact that it was a disease peculiar to swine. The analysis 
of the blood of scrofulous subjects shows that it differs 
materially from that of healthy individuals. In the 
former there is an excess of serum and a deficiency of 
albumen and fibrin. Hence the solids formed from this 
blood are feeble, lax and incapable of resisting exposure, 
fatigue and disease. It is true that for the most part 
scrofula is hereditary, still there are many well-marked 
cases of the acquired disease from the use of pork. 

VEAL, 

Or the flesh of the calf, is not so digestible as beef ; it 
contains a large amount of gelatinous substance, as is 
the case with the meat of all young animals. The best 



56 THE FAMILY PHYSICIAN 

mode of cooking is by roasting or baking. Broth made 
from real generally produces a laxative influence on the 
bowels, and may be used with advantage by persons 
subject to constipation. A tea of veal, made in the same 
manner as beef-tea, from a fillet or knuckle of veal, is 
sometimes of advantage to the invalid. 

LAMB 

Is a wholesome diet for persons in health. It is less 
stimulating and less solid than mutton, but is not so 
digestible. It may be used by convalescents, but not by 
dyspeptics and persons laboring under affections of the 
stomach, with whom it will generally be found to disa- 
gree. A lamb should not be killed too young for diet ; 
at the age of from five to seven months is preferable to an 
earlier period. 

SALTED MEATS, 

As before observed, are less nutritious and harder to 
digest than fresh meats. They should always be 
thoroughly boiled and eaten with a good proportion 
of vegetable food. The fat of meats is very nutritious 
and requires strong digestive powers, hence it is not so 
suitable for the sedentary, dyspeptics and persons of 
weak stomachs ; when eaten it should always be with at 
least an equal amount of lean meat and some bread, rice, 
potatoes or other farinaceous article of diet. Too much 
fat causes uneasiness, weight, oppression, eructations and 
affections of the digestive apparatus. It is positively 
unhealthy when fried or roasted, and should never be 
allowed to children and invalids in any form. 

GAME, OK BIKDS AND BEASTS 

Living in a natural state, and which are killed in this 
condition, are in general more healthful when cooked in 



AXD GUIDE TO HEALTH. 57 

a plain manner than the same animals when tamed and 
killed in the nsnal mode. 



By which is generally meant all farm-yard birds, as 
chickens, hens, ducks, turkeys, &c, are generally very 
digestible and healthy food for persons having stomachs 
free from disease. Chickens and turkeys are considered 
the most easy of digestion if not too richly seasoned, 
and geese and ducks are less digestible and more stimu- 
lating, usually being injurious to dyspeptics and persons 
whose digestive powers are not very strong. The dress- 
ing usually employed when baking or roasting these 
birds is extremely stimulating and indigestible on 
account of the fat and spices mixed therewith. 

Chicked Soup is a light, nourishing diet and may be 
used by many sick persons and convalescents. It is 
best when made from lean portions of the chicken, which 
should be boiled in water to which a little salt has been 
added, and as the fat scum arises it should be removed. 
Crackers, rice, barley or toast bread may be added to it 
to increase its nutritiveness if desired and not contra- 
indicated. When highly seasoned with spices it becomes 
an improper diet, especially for dyspeptics and conva- 
lescents. 

FISH 

Furnishes an almost endless variety of food for man, and 
in some countries, especially in the northern parts of the 
two continents where vegetation is scarce, they form the 
principal diet of the inhabitants. However, they are not 
so nourishing as the meat of warm-blooded animals, but 
are sufficiently so to support health and strength. With 
many stomachs fish meat is difficult to digest, and when 
it is eaten habitually it frequently induces disease of the 



58 THE FAMILY PHYSICIAN 

"bowels and of the skin. Some individuals are very apt 
to Ibe affected by eating certain kinds of fish, experienc- 
ing a disagreeable, uneasy sensation at the stomach, a 
small amount of fever and an eruption on the surface of 
the body ; these symptoms are also produced occasionally 
in deranged conditions of the digestive apparatus. All 
kinds of fish, when out of season, are of difficult diges- 
tion and very unhealthy, and in some situations they 
become poisonous. Salt water fish are always better 
than those living in fresh water, as they possess a firmer 
and more pulpable flesh which is less liable to putridity 
and is less clammy or slimy. Many persons can not eat 
fresh water fish at all without inducing an attack of 
cholera morbus or other difficulty. Fishes having scales 
are usually more digestible than others; thus the cod, 
shad, trout, perch, fresh herring, plaice, flounder, turbot, 
whiting, &c, are the most healthy and nutritious, while 
eels, skate, sturgeon, mackerel, salmon, &c, are much 
less digestible and wholesome. Indeed all fish which 
abound in oil are stimulating and difficult of digestion. 
Fish are best cooked by boiling ; when fried or stewed 
they are rendered quite indigestible. Butter should not 
be used as a sauce for fish nor the acid fruits or jellies, 
as they almost always produce heaviness or uneasiness 
of the stomach. Milk is a very improper article to be 
used at the same time with fish, frequently inducing 
severe diarrhea, cholera morbus, &c. When fish are 
dried and salted they become less nutritious and di- 
gestible, and should never be eaten except by the healthy 
and hard working, and even by them should be used 
very sparingly. 

OYSTEES 

Furnish a delicious and favorite food ; when raw or but 
slightly cooked they are light, nourishing and easy of 



AXD GUIDE TO HEALTH. 59 

digestion, with the exception of the eye or tough white 
part, which should never be eaten. When well cooked, 
as by stewing or frying, the albumen is coagulated and 
hardened and the fibrin is corrugated, when they become 
quite indigestible and should not be eaten. Salt water 
oysters are always better than those found or propagated 
in rivers. Oyster juice thickened with cracker in powder 
and warmed is frequently a wholesome and nutritious 
diet for persons having weak stomachs and convalescents. 
With some constitutions oysters disagree, and they 
frequently prove injurious when eaten out of season. 

SOUPS, 

As ordinarily prepared from beef, mutton or veal, with 
the addition of various vegetables, are a very healthy, 
nutritious and inexpensive diet. The meat as well as the 
vegetables should be thoroughly boiled, and too much 
seasoning should be avoided. They may be improved by 
the addition of rice or barley, stale bread, toast bread, and 
will digest more readily when eaten with bread, because 
liquid food is apt to swell out the stomach and render 
a greater action of the organ necessary for its perfect 
digestion. Solid aliments are, however, the best suited 
for weak stomachs and dyspeptics. The addition of 
dumplings to soups or excess of spices, wine, &c, are 
very improper, as they tend to provoke the appetite, by 
which a greater quantity of food is eaten than is required, 
besides which they are rendered highly indigestible ; and 
if a course of this kind is persisted in the stomach will 
certainly become diseased. When meat has been boiled 
for a long time in water, to which a small quantity of 
salt has been added, it is termed broth. This eaten with 
bread affords considerable nourishment without unduly 
stimulating the digestive apparatus or augmenting the 
heat of the body. 



60 THE FAMILY PHYSICIAN 

EGGS, 

When fresh and lightly cooked, are nutritive and mode- 
rately easy of digestion. The white of the egg is princi- 
pally composed of albumen, while the yelk contains in 
addition to it a yellow oil. When the albumen is coagu- 
lated or hardened by heat it is not thereby rendered 
indigestible, but the yelk is. Although hard-boiled eggs 
are, as a general rule, difficult of digestion, yet they are 
sometimes found to agree with certain persons better 
than when in a soft state. Vinegar is said to facilitate 
the digestibility of a hard- cooked egg. All articles in 
which eggs are cooked by frying, as omelettes, pan- 
cakes, fritters, &c, are hurtful to delicate stomachs. 
When an egg is whipped up with wine and sugar it 
forms a valuable restorative and stimulant. 

MILK, 

When obtained from a healthy, well-fed animal, 
is very nutritious and wholesome, and is more 
advantageous in its raw state than when boiled. In 
combination with bread, rice, sugar, egg, &c, it ought to 
form the chief portion of the diet of children until they 
are ten or twelve years of age ; and those who are thus 
fed will be found stronger and more healthy and vigor- 
ous than those who are allowed to live upon meat, pies, 
cakes and other delicacies of the culinary art. It is a 
preferable drink to tea, coffee, liquors, &c, and may be 
used pure or considerably diluted with water. A glass 
of milk and water with a teaspoonful of salt added is 
said to be the best refreshment that a fatigued or famished 
person can take. One part of lime water added to two 
or three parts of milk is useful to check obstinate vomit- 
ing and to allay irritability of the stomach, especially 
when connected with acidity, as in consumption and other 



AND GUIDE TO HEALTH.- 61 

debilitating diseases. Milk sometimes disagrees with 
adults, probably owing to its oily constituent — butter. 
It is very unfortunate for the inhabitants of large cities 
that no regulations can be adopted by which they 
may be certain of obtaining good, pure milk. The slop 
milk from diseased cows, together with the impurities 
added to increase the quantity of artificial milk, and 
thereby increase the profits pecuniarily of the vender, 
have undoubtedly caused a great amount of the sickness 
in cities, especially among children. It were much 
better to do entirely without milk than to make use of 
the trash commonly sold for it in most of our cities. 

BUTTERMILK 

Is the residue of milk after its butter has been removed 
by churning. It consists of caseine, sugar, serum and a 
little butter. It forms a very agreeable, cooling beverage 
in warm weather, and is especially beneficial in fevers 
and inflammations. It is very slightly nutritive and of 
easy digestion, but should not be allowed to become too 
acid before using it. Some persons are very fond of 
boiled rice and buttermilk, while to others it is extremely 
disagreeable; it is a nutritious, healthy diet, however, 
when it agrees with the stomach. 

BUTTER 

Is an oily substance, of soft consistence, procured from 
the milk of animals by agitating it constantly for a 
length of time, which process is termed " churning." 
Ewe's milk contains the largest amount of caseine and 
butter, and is consequently less digestible and unfit for 
dyspeptics. Goat's milk ranks next, relative to its nutri- 
tive principles, and of which the same remarks may be 
made as of ewe's milk. Ass's milk is the least nutritive, 



62 THE FAMILY PHYSICIAN 

but of the most easy digestion, and, on account of the 
small quantity of butter and large quantity of sugar of 
milk which it contains, it is very useful in convalescence 
from acute maladies, consumption or dyspepsia. It is 
sometimes prepared artificially by dissolving a couple 
of ounces of sugar of milk in a pint of skimmed cow's 
milk. The butter used at meals is obtained from the 
cow's milk, which is intermediate in nutritive and diges- 
tible properties between goat's milk and ass's milk. 

Butter is used rather as a condiment than as a direct 
alimentary matter. It is very difficult of digestion, on 
account of the readiness] with which its volatile, fatty 
acids are set free. Yet, when it is fresh and sweet, and 
spread not too thick upon bread, there are very few 
stomachs which it offends. When it becomes rancid it 
is peculiarly unpleasant and unhealthy, and should never 
be used for any purpose as diet. All fixed fats and oils 
of animals are of more difficult and slow digestion than 
any other alimentary principles, and with dyspeptics 
they are very imperfectly digested. Still, in small 
quantities, they are frequently beneficial among the 
robust and healthy ; and in many diseases, where the 
digestive functions are perfect, a moderate employment 
of them is followed by an improvement of the general 
health. 



AND GUIDE TO HEALTH. 63 



ARTICLES OF VEGETABLE DIET. 



Of these I will speak very briefly. They are much 
more numerous than those of the animal. The most 
important of them are cereal grains, as wheat, corn, oats, 
barley, rice, &c, and the nourishing power of which 
depends principally upon the glutin, starch and gum 
which form part of their composition. 

WHEAT 

Contains much more of the glutin and fibrin than any 
other farinaceous articles, owing to which wheat flour 
forms a superior article to any other for the preparation 
of bread. 

COKN. 

Corn meal is extensively used in the United States for 
bread. It furnishes a healthy, palatable diet, and is 
very nutritious ; it does not contain glutin, hence it does 
not rise like wheat flour. I deem it unnecessary to enu- 
merate the various articles of vegetable diet or to note 
their mode of preparation. This is generally sufficiently 
understood by all classes for practical purposes. 

EKUIT. 

I do not propose to enumerate the varieties of fruit. 
I will only say, fruit is healthy and useful when used 
ripe. The most important, perhaps, in the United States 
is apples, as they can be easily had all the year. Grapes, 



64 THE EAMILT PHYSICIAI 

however, during their season, is, I think, beyond a doubt, 
superior to any thing else. It is gratifying, indeed, to 
note the interest that is now "being manifested in the 
culture of this precious fruit. For "both table use and 
wine it is destined to "become the most deservedly popu- 
lar of any other fruit in America, and while it "bids fair 
to "become a national blessing it also promises to be the 
most lucrative business the American farmer can engage 
in. The wine of the American grape is fast growing 
into general favor. Intelligent physicians now. prescribe 
it in preference to alcohol in any other form. The most 
popular varieties now are the Norton's Virginia Seedling, 
the Clinton, the Herbemont, Catawba and Isabella. 
First in the list stands the Norton's Virginia Seedling, 
as a lieavy wine ; but the Clinton will compete fairly if 
not successfully with it in every respect ; and, as it can 
be produced cheaper, will become the wine for the masses. 
For table use, from its abundance and easy growth, the 
Concord will perhaps stand long at the head of the list. 
Many other varieties are excellent for table use, and as 
the Hartford prolific is some weeks earlier every vine 
grower should raise it. 

Every farmer should put out at least a few apple trees, 
peach trees, pears, prunes, cherries, &c, with a small 
variety of grape vines, gooseberries, currants, raspber- 
ries, blackberries, strawberries, &c. The time and cost 
would scarcely be missed, while they would afford him 
all the fruits he would want for his family. Their cul- 
ture would only be a source of amusement and happiness 
for the family. It is pleasant to note the commendable 
desire that is now manifested in this country to grow 
fruit. Its abundant harvest will be reaped by the rising 
generation, who will, all things else being equal, be a 
more cheerful and healthy people than we are. I would 



A^D GUIDE TO HEALTH. 65 

be glad to liave more time and space to devote to this 
subject ; it is one that has been much neglected by the 
medical profession, who are, or ought to be, the guard- 
ians of the public health. The physician has not dis- 
charged his whole duty when he cures disease, but he 
should, at all times, do and say all in his power to pre- 
vent disease and premature decay, and to promote the 
general health of the community, by recommending such 
sanitary measures as he can and urging the people to 
adopt them. 

I know from a long experience how hard it is to get a 
well man to observe any laws of health ; he generally 
waits until disease has taken hold of him before he moves 
in the matter. Bitt there is a different spirit awakening 
in the minds of the people now, and I do hope it will 
increase until premature death will be as rarely met with 
as old age is now. Such a state of things can be had by 
knowing and observing the laws of life and health. 



66 ■ THE FAMILY PHYSICIAN 



DRINKS 



WATER, TEA, COFFEE, AND ALCOHOLIC 
BEVERAGES. 

Every drop of fluid taken into the stomach is conveyed 
into the, blood, and before it is expelled from the system 
it traverses every part of the body. 

WATEB 

Is as essential to life as air, heat or light ; it enters into 
almost every snbstance which constitutes the food of 
man, and is, indeed, the proper solvent of all solid, 
nutritious substances. 

The only fluid which is suitable for an ordinary drink, 
and which is the best suited for the nourishment of the 
system, for the dilution of solid food, and for the main- 
tenance of a proper degree of fluidity in the blood, is 
water. Indeed, water is the only agent that can satisfy 
thirst, or which the natural taste of man prefers. 
Tastes for alcoholic drinks, tea and coffee are vitiated 
tastes acquired— they are artificial; yet, under certain 
circumstances, it is found advisable to combine with the 
drinks farinaceous, mucilaginous, acidulous, or aromatic 
substances, as in cases of sickness, convalescence, debil- 
ity, during excessive heat, and in instances where water 
alone disagrees. 

The purer the water the better it is for health. Many 
fatal epidemics have been commenced by the use of im- 



AND GUIDE TO HEALTH. 67 

pure water. It doubtless plays an important part in 
cholera epidemics, either as a predisposing or, as some 
think, an exciting cause. Dr. Snow thought that the 
poison was produced in the alimentary canal and existed 
in the cholera evacuations, and that the leakage of 
drains, cess-pools, &c, contaminated water, which, when 
drank, communicated the disease. Dr. G-oodeve says 
that it is certain that impure water promotes the spread 
of cholera. 

A great number of diseases have been traced to the 
use of impure water. Rain water is the most pnre of all 
water, and this every farmer can have by bnilding him 
a cistern. Persons in large cities are compelled to nse 
water from rivers, which will do well enongh if it con- 
tains no substance prejudicial to health or life. Spring 
water often approaches nearer to purity than any other 
save rain water, and is excellent if it is soft. Hard water 
contains certain mineral matters in solution, which lessen 
its solvent powers and occasion abnormal conditions of 
the blood, from which arise many diseases. Soft water, 
or " freestone water," should always be nsed. 

Marsh or stagnant water always contains vegeto-ani- 
mal matters in a state of decomposition, giving rise to 
peculiar acids or poisonous gases ; hence they are very 
unhealthy, some occasioning ague, dysentery, and a 
great many other dangerous and troublesome diseases. 
They should never be used for domestic or medical 
purposes. 

TEA — GBEEN" AND BLACK. 

In speaking of this article as a drink I fear I shall 
bring down a shower of abuse upon my head from my 
fair readers, for amongst them it has grown into general 
use, and has become a general favorite. I dislike exceed- 
ingly to say any thing that is calculated to offend them,. 



68 THE FAMILY PHYSICIAN 

for in such cases I always have visions of "broomsticks, 
&c. But in writing this work I have a solemn duty to 
perform, and I will perform it if half a score of women 
were across the river pointing broomsticks and shaking 
their pretty fists at me. Tea, if used in moderation and 
only two or three times a week, is a grateful and harm- 
less beverage, but if used for a long time in large quan- 
tities, or of great strength, it is exceedingly pernicious ; 
it induces many unpleasant, nervous and dyspeptic 
symptoms, as wakefulness, tremors, palpitations, anxiety, 
and other distressing feelings. Tea possesses gently 
exciting and astringent qualities or properties ; it also 
exerts an influence on the brain and nervous system. For 
a beverage, black tea, if -it is pure, is preferable to green, 
as it contains less stimulating and narcotic principles ; 
and it should never be used except at the evening meal, 
unless in cases of sickness, debility, &c. Green tea is 
best adapted in cases of sickness, in fevers, and in 
inflammatory diseases, colds, catarrh, and after a fit of 
intemperance ; it rarely disagrees with the invalid, and 
often proves refreshing and agreeable, acting, if drank 
warm, as a diluent, diaphoretic and diuretic. 

Tea, whether green or black, should never be used 
daily by persons in health ; it should only be drank in 
moderation, at an evening meal, when the system is 
depressed or languid from exercise or the labor of the 
day. When the debility experienced at this time is 
owing to the heat of the season only there is no better 
fluid to overcome it than pure cold water ; other drinks, 
however, are admissible, and may be used at the supper 
table, as buttermilk, toast water, sage tea, milk, or 
lemonade. 

Persons should accustom themselves to vary their 
breakfast and supper beverages, and not use the same 



AND GUIDE TO HEALTH. 69 

liquid daily, remembering that there is no fluid so 
thoroughly adapted to the wants of the system as pure 
cold soft water, and the more this is interfered with by 
the addition of foreign agents, the less healthful and 
beneficial it is rendered. 

Cli ildren should never drink tea, except when required 
as a medicinal, refreshing draught. Persons of sedentary 
or inactive occupations require much less tea as a stimu- 
lant than those of active habits ; often, when they use 
tea and coffee daily, they are subject to vertigo, head- 
ache, oppression at the stomach, which symptoms often 
disappear when water is substituted for these stimulants. 
I will not attempt here to speak of the adulterations of 
tea, but simply say it is not a nutrient, but simply a 
nervous stimulant that is seldom needed by any one. 
Still it is a harmless, pleasant beverage if taken in small 
quantities, and may be occasionally indulged in. 

COFFEE. 

I now come to speak of another popular and favorite, 
but somewhat pernicious beverage — coffee. It, too, is 
simply a stimulant, and not a nutrient to any extent 
worthy of mention. 

There are several varieties, among which the Mocha, 
Java and Havana are considered the best. The infusion 
of torrefied coffee grains, after they have been properly 
roasted and pulverized, forms a well known and favorite 
beverage. Taken in moderation, with a proper amount 
of sugar and cream, it is a gentle, pleasant stimulus, but 
generally occasions a degree of wakefulness ; in large 
quantities it produces derangement of the nervous 
system and the digestive organs, and if its use is per- 
sisted in it will generally produce dyspepsia. 

Coffee should never be taken in large quantities nor 



70 THE FAMILY PHYSICIAN 

in very strong inf nsion, because it seldom fails to derange 
the stomach and injure digestion; it may also occasion 
wakefulness, tremors, headache and loss of memory, 
with many other unpleasant symptoms ; many persons 
can not use it all on account of its disagreeable effects. 
The writer belongs to this number. 

The stimulating effects of coffee, like those of intoxi- 
cating liquors, are always followed by a depression pro- 
portioned to the quantity and strength of the infusion 
employed and the degree of excitement occasioned by it. 
Constipation is one of the common effects of coffee. 

Persons of sedentary habits, dyspeptics and children 
should not use coffee save as a medicine ; it is occasion- 
ally useful in the sick room, and relieves some forms of 
headache. It is an excellent antidote to the baneful 
effects of opium, morphine or alcohol. It is, likewise, a 
valuable stimulant, in connection with brandy and opium, 
in cases of extreme exhaustion from hemorrhage from 
any cause. 

Coffee may be used by most persons in moderation, 
but should always be with sugar and cream. 

ALCOHOLIC BEVEEAGrES. 

Spirits or alcoholic drinks used as a beverage are, 
unquestionably, the curse of the present age. 

From the pure juice of the native grape, after it has 
undergone fermentation, through the long filthy list of 
lager, ale, porter, rum, gin. and brandy, to the pure 
alcohol itself, death, moral and physical, is written in 
the cup. If I were able to borrow the golden tipped 
pencil of the tallest angel that basks in the glorious 
light of heaven, and could paint with artistic skill across 
the broad disc of heaven, I would say, in living, flaming, 
burning letters of gold, so bright and so dazzling that 



AXD GUIDE TO HEALTH. 71 

every one could see, " Touch not, taste not, handle not 
the unclean thing." Death lies in the cup — death to the 
soul as well as to the body. And, strange to say, even in 
this enlightened age, while reform is the watchword in 
almost every thing, drunkenness is on the increase. 

I have said it was the curse of the present age. It is 
the sin of our land, and, with our boundless prosperity, 
is coining in upon us like a Hood ; the sluice gates are 
thrown open. And if any thing shall defeat the hopes 
of the world which hang upon our experiment of civil 
liberty, it is that river of liquid fire which is rolling 
through the land, destroying the vital air and extending 
around an atmosphere of death. 

' ; Who hath woes? Who hath sorrows? Who hath 
contentions I Who hath babblings ? Who hath wounds 
without cause ? Who hath redness of eyes ? 

" They that tarry long at the wine ; they that go to 
seek mixed wine." 

No pencil but that of inspiration could paint so many 
vivid traits of this complicated evil in so short a com- 
pass. It exhibits its woes and sorrows, contentions, and 
babblings, and wounds. 

It is not my purpose in this work to try to lay bare 
the great sin of intemperance or present it in its moral 
aspect ; the moral ruin it works in the soul gives it the 
denomination of giant wickedness. Of its effects on the 
human system I feel it my duty to speak. God has 
made the human body to be sustained by food and sleep, 
and the mind to be invigorated by effort and the regular 
healthfulness of the moral and physical system. Who- 
ever, to sustain the body, or invigorate the mind, or 
"cheer the heart," applies habitually the stimulus of 
ardent spirits, does violence to the laws of his nature, 
and puts the whole system into disorder. 



72 THE FAMILY PHYSICIAN 

The stomach is the great organ of accelerated circula- 
tion to the Mood, of elasticity to the animal spirits, of 
pleasurable or painful vibration to the nerves, of vigor 
to the mind, and of fullness to the cheerful affections of 
the soul. Here is the silver cord of life, and the golden 
bowl at the fountain, and the wheel at the cistern ; and 
as those fulfill their duty, the muscular and mental and 
moral powers act in unison and fill the system with 
vigor and delight. But as these central energies are 
enfeebled the strength of mind and body declines, and 
lassitude and depression, melancholy and sighing succeed 
to the high beating of health, and the light of life becomes 
as darkness. Experience has decided that any stimulus 
applied steadily to the stomach, which raises its muscu- 
lar tone above the point at which it can be sustained by 
food and sleep, produces, when it has passed away, de- 
bility — a relaxation of the over- worked organ propor- 
tioned to its excitement. The life giving power of the 
stomach falls, of course, as much below the tone of cheer- 
fulness and health as it was injudiciously raised above 
it. Experience has also shown that the phenomena of 
which we have to treat under the denomination of alco- 
holism are due to the direct action upon the nervous 
system of a blood-supply charged with a high per cent- 
age of alcohol. If we surround a living nerve with 
alcohol of a certain strength, we find that it becomes 
paralyzed, i. e., incapable of transmitting impressions 
through the part to which the alcohol has been applied ; 
while a very weak mixture of alcohol and water is inca- 
pable of producing this effect. Similarly, if an animal 
absorb into its circulation a certain quantity of alcohol 
within a given time, the nervous centres and the peri- 
pheral nerves become in a degree paralyzed. That this 
effect is, at least in part, due to direct action of strong 






AND GUIDE TO HEALTH. 73 

alcohol upon tlie nervous tissue can not be doubted; 
there is, however, a co-operative canse of no small 
importance — namely, it has been ascertained by the 
researches of various observers that the impregnation of 
the blood with large quantities of alcohol interferes with 
its absorption of oxygen ; it thus becomes unfitted to 
support healthy nervous functions. Under these com- 
bined influences the nervous tissues, and particularly 
those of the central organs, become more unfitted for the 
performance of their proper functions ; and this change 
progresses with a rapidity proportionate to the strength 
and frequency of the alcoholic influence. 

It may be necessary to recall the principal facts which 
are known with respect to the action of alcohol upon the 
organism. Alcohol is readily absorbed from the stomach 
when it is empty. If the dose be moderate and the 
administration well timed, the effect upon the nervous 
system is simply that of a restorative stimulant. Sensa- 
tions of fatigue are dispelled, the mind works more freely, 
a healthy sense of warmth is diffused through the body, 
and the arterial system acquires an increased tonicity if 
it was hitherto deficient in that quality. The small blood 
vessels, when relaxed in a condition of fatigue, are 
brought by a moderate dose of alcohol to a proper ten- 
sion, from which they suffer no recoil. It has also been 
shown by able chemists that alcohol is a nutrient. For 
these reasons we find it sometimes indicated, and the 
best physicians of the land prescribe it ; and I would 
remark here that when it is thus indicated I know of 
no other article that can be properly substituted for 
it as a medicine. If, on the contrary, the dose has been 
immoderate or administered at a time when it was 
not indicated, the pulse waves with a precisely oppo- 
site indication — that, namely, which proves that arterial 



74 THE FAMILY PHYSICIAN 

relaxation has occurred, and simultaneously with this the 
pnlse becomes abnormally quick. At the same time other 
symptoms of a paralytic nature are observed, confined 
in the first instance to the spinal nerves and to the fifth 
cranial nerve. The former show their weakness by the 
occurrence of slight feelings of nnmbness and an impair- 
ment of muscular sense in the extremities ; the latter 
indicates its affection by the occurrence of slight numb- 
ness of the lips. The vaso-motor fibres of the fifth nerve 
discover their partially palsied condition by flushing of 
the face and redness and watering of the eyes. The 
cerebral hemispheres next give notice of the alcoholic 
influence by the occurrence of intellectual confusion, and 
the hypoglossi becoming simultaneously affected, the 
muscular movements of the tongue become diflicult and 
articulation is impeded. The further stages of drunken- 
ness consist in more or less noisy or sentimental delirium, 
passing gradually into coma ; palsy, more and more com- 
plete, of voluntary motion and sensation ; the medulla- 
oblongata is palsied and breathing ceases ; and, last of 
all, the organic nerves of the heart become incapable of 
performing their functions, and cardiac life ceases. 

The irritant effects of alcohol on the alimentary canal 
are chiefly seen in the case of strong spirit drinkers, and 
more particularly in those who drink spirits " strait " 
(neat) or highly concentrated. Beer drinkers do, indeed, 
often suffer from a simple form of dyspepsia, and there 
is little doubt that slow degenerative changes are usually 
set up in the stomachs of those subjects; but, except in 
cases of enormous habitual excess, the dyspepsia is a 
transient phenomenon, which rapidly disappears on the 
adoption of a rigid plan of abstinence together with a 
simple medicinal treatment. The more concentrated 
alcohols, however, when used for any length of time, 



AND GUIDE TO HEALTH. 75 

may set up a formidable irritation, which produces in- 
tense congestion of the stomach or the intestines, or both ; 
in short, a greater or less portion of the tract in which 
the radicles of the portal vein take their rise is subject 
to severe engorgement. Perhaps the most serious conse- 
quence of such an action is the occurrence which we now 
and then witness of profuse hemorrhage from the stomach 
or bowels. 

Of the earliest symptoms which indicate a dangerous 
degree of nervous degeneration, the occurrence of marked 
sensory paralysis is one of the most frequent. Unlike 
the corresponding affections of the motor nerves, sensory 
paralysis is commonly exhibited in a slight degree in 
the upper extremities before it appears in the lower. 
The occurrence of any considerable degree of sensory 
palsy in the lower limbs is a sign of grave import ; the 
patient so affected, unless he be induced at once to adopt 
a proper abstinence and an appropriate medicinal treat- 
ment, is almost certain very quickly to experience some 
organic lesion of the brain. Simultaneously with the 
occurrence of a considerable degree of sensory paralysis 
there is usually a great development of the muscular 
tremor, which often approaches closely to the type of 
paralysis called agitans. The mental powers are by 
this time usually affected in a marked degree — the most 
common mental condition being one of general intel- 
lectual enfeeblement and moral degradation, marked at 
this stage by cowardice and untruthfulness. At this point 
the progress of the case may diverge in either of several 
directions. In patients whose family history is strongly 
marked with the taint of insanity a tendency to suicide 
is often developed, or else the sufferer sinks rapidly into 
a state of confirmed and incurable dementia. In others 
the functions of muscular co-ordination is interfered with 



76 THE FAMILY PHYSICIAN 

to a degree which makes the case resemble at first sight 
the affection known as Locomotor Ataxy. In others 
there occurs a sudden break down of nervous fibres in 
the corpora striata or optic thalami, which produces a 
stroke of hemiphlegic paralysis. In others, along with 
some symptoms of mental alienation, a general motor 
palsy is so distinctly observed as strongly to suggest the 
idea of commencing general paralysis of the insane. In 
others the rupture of a cerebral artery leads to an effusion 
of blood, and the sudden occurrence of an attack resem- 
bling ordinary apoplexy. This is the apoplexy that so 
many respectable men and women in our great cities die 
with. In other cases the patient suffers attacks of con- 
vulsions, which can not be distinguished from those of 
epilepsy ; this condition indicates a hopeless condition of 
the nervous centres. They are almost always accom- 
panied by an advanced degree of dementia. 

Acute alcoholism presents itself under four heads: 
Delirium Tremens, Acute Mania, Acute Melancholia and 
Oinomania. These are the terrible sequalea of the im- 
moderate use of alcoholic drinks; this is the condition 
the physical system is brought to by strong drink. 

Thus I have given, carefully and correctly, the effects 
upon the physical system, that men may not blindly 
destroy themselves, and may desist. I have not over- 
drawn a single effect. I have adhered strictly to the 
unerring developments of scientific investigation and 
observations, and the drunkard may depend most cer- 
tainly upon realizing the terrible symptoms above given ; 
and not only realize the terrible symptoms himself, but 
there is no fact more certain than the transmission of 
temperament and physical constitution, according to the 
predominant moral condition of society, from age to age. 
Luxury produces effeminacy and transmits to other gen- 



AND GUIDE TO HEALTH. 77 

erations imbecility and disease. Bring up the genera- 
tion of the Romans who carried victory over the world 
and place them beside the effeminate Italians of the 
present day, and the effect of crime upon the constitution 
will be sufficiently apparent. Excesses unmake the man. 
The stature dwindles, the joints are loosely compacted, 
and the muscular fibre has lost its elastic tone. No 
giants' bones will be found in the cemeteries of a nation 
over whom the waves of intemperance have rolled for a 
century. 

The duration of human life and the relative amount 
of health or disease will manifestly vary according to 
the amount of ardent spirits consumed in the land. As 
the jackal follows the lion to prey upon the slain, so do 
disease and death wait on the footsteps of inebriation. 

In view of the evil effects of intemperance, physically, 
I beg the rising generation at least not to use spirits in 
any form as a beverage. Do not attempt to be a 
"moderate drinker;" nine out of every ten moderate 
drinkers become drunkards. It is the moderate drinker 
that forms the drunkard. An appetite is created for the 
destroyer that few indeed can resist; and before you 
know it, notwithstanding all your resolves, you are a 
drunkard, a hopeless inebriate. You know and fully 
understand your condition, you feel that you are 
degraded, and imagine that you never can again be 
received into respectable society, you know that through 
your own folly your wife and little ones are in a state of 
starvation, you compare your former with your present 
state, and all other thoughts so harass you that you 
hasten to the fatal cup to silence them, to bury them in 
the insanity of alcohol. 

What is drunkenness ? Go visit your prisons, and 
among their dreary cells behold the house-breaker, the 



78 THE FAMILY PHYSICIAN 

felon, the murderer, the outlaw, who fears neither the 
laws of God or man. Go visit your hospitals, and among 
their inmates behold those who are afflicted with disease, 
paralysis, convulsions and insanity. Go visit your rum 
holes, your sinks of iniquity, where thieves, paupers 
and murderers are manufactured, and observe the 
bleared eye, the bloated countenance, the palsied and 
tottering frame, the staggering gait, the poverty and 
wretchedness, and the detestable deeds of vice every- 
where apparent, and hear the oaths and curses, the vile, 
obscene and loathsome language, which issues from the 
lips of the inhabitants of these vile dens of sin. And, 
when your soul sickens with the sight of human misery 
and depravity — has turned away filled with horror, 
disgust and detestation — know that all this is drunken- 
ness ! All this is the effect of rum. 

Shakespeare says : " Oh, thou invisible spirit of wine, 
if thou hast no name to be known by, let us call thee 
devil." " Oh, that men should put an enemy in their 
mouths to steal away their brains." He might have 
added., to steal their lives and souls. 

The direct diseases brought on by alcoholism — delirium 
tremens, acute mania, acute melancholia and oinomania — 
will be treated under their respective heads. 



A]SrD GUIDE TO HEALTH. 79 



OPIUM EATING 



The pernicious habit of opium eating has become an 
evil so wide spread that it demands a notice here. Like 
whisky it is destroying the minds and constitutions of 
thousands of our fellow men. The number of opium 
eaters in almost every city in the Union, and in many 
portions of the country, would astonish any one who is 
not posted on the extent of this vice. This is fashion- 
able drunkenness. Ladies who would scorn the very 
idea of drinking spirits will get gloriously and " obliv- 
iously" drunk on opium. Ladies of the highest res- 
pectability have been arrested on the streets of New 
York city lately for drunkenness, caused by opium. 
The amount of opium sold by druggists to habitual 
eaters is perfectly marvelous — particularly in the large 
cities. 

Is it a less shameful act to be drunk on opium than it 
is on alcohol? Is the injury sustained by the system 
less? Certainly not. Opium in excessive doses is a 
powerful narcotic poison, producing soon after it is 
taken giddiness and stupor, with scarcely any previous 
excitement ; the stupor increases rapidly, accompanied 
with complete torpor, slowness of breathing, depression of 
circulation, general relaxation of the muscles, contracted 
pupils, and, unless active treatment be speedily em- 
ployed, death quickly ensues. This is the effect of that 
drug in excessive doses ; but in smaller doses it produces 
at first excitement of the vascular system, which is 



80 THE FAMILY PHYSICIAN 

accompanied with exhilaration of the nervous functions, 
with increased heat of the body and pleasurable sensa- 
tions throughout the whole system, even in a higher 
degree than they are produced "by champagne or brandy. 

For this sensation the drug is eaten. An individual 
under the influence of opium talks and laughs, and feels 
exceedingly happy, while he presents all the appearance 
of intoxication from alcohol, staggering and falling in 
the same ludicrous and awkward manner ; in short, pre- 
senting all- the loathsome and degrading phenomena of 
a " drunk" on mean whisky. Is not the thought of this 
enough to crimson the cheek of the fair opium eater, who 
daily makes herself drunk on this poisonous drug. It 
is with reluctance and pain that I charge the gentler sex 
with crime, or often indiscretions, but truth compels me 
to lay the curse of opium eating chiefly at their doors. 
It is a lamentable fact that the female opium eaters 
largely outnumber the male sinners in 'that habit. This, 
perhaps, is owing to the fact that men can step into a 
bar-room on almost any square and " smile," while 
opium or morphine is the most convenient for the ladies. 

I know men of talent and ability who have used 
opium until they are worthless for any kind of business 
without it. They are as nervous without their opium or 
morphine as the old sot is without his rum. I know 
ladies of high respectability who are in the daily habit 
of getting intoxicated on some of the forms of opium. 
They carry it to such an excess that they often have to 
feign " headache " (ever woman's convenient shield), and 
go to bed to prevent exposure. Others take a large dose 
at bed time so as to experience the pleasant sensation 
for a few minutes, and then to become oblivious to every 
thing until a late hour next morning. 

If the pernicious habit was confined to only a few 



AND GUIDE TO HEALTH. 81 

misguided, selfish individuals the fact would not be so 
lamentable, but the number who are thus on the high 
road to ruin is fearfully large — their "name is legion." 

This thing is a matter of no small importance to the 
people of the present age ; it bids fair to outstrip the 
fearful sin of chinking. Its devotees are a class who are 
doing much to bring about a reform in drinking. The 
women are doing much everywhere for the cause of 
temperance. They are reforming their husbands, fathers, 
brothers and neighbors. They are building up a mighty 
temperance cause in this country — one that will ere 
long wield a mighty political power, and one that will 
save hundreds and thousands of our race from disgrace 
and ruin. It does my heart good to place this great and 
important work to their credit. But while this is the 
case I will not shut my eyes to the fact that they are 
nursing a habit more dangerous in its influences, more 
fatal in its effects, and one better calculated to fasten its 
poisonous fangs on its victim heart's and destroy them. 
Opium eating can be done better " on the sly " than 
whisky drinking, owing to the small quantity necessary 
to produce drunkenness ; the sensation produced by it is 
more pleasant, and there is not that odium attached to a 
" drunk " on opium that there is on whisky or other 
drinks. For these reasons it is fast growing into popu- 
larity, and bids fair to-day to be the great curse of the 
age. 

Now, ladies, my gentle friends, let me implore you to 
frown on this evil ; if you have begun the pernicious prac- 
tice, desist — you who are first in all that is good and noble, 
you who ever raise your warning voices against " every 
appearance of evil," who are first to train the youth in 
the ways of piety, who are the first to obey the everlast- 
ing gospel, who are the first to move in every great work 
6 



82 THE FAMILY PHYSICIAN 

of philanthropy, whose hearts and hands are first open 
to the poor, yon withont whom how Iblank and dreary 
wonld he life, yon to whom we owe onr present exist- 
ence. To yon we owe the cultivation of onr plastic minds 
in childhood, forming ns for the pnrsnits of more matured 
life, giving to ns impressions which can never "be effaced 
by the busy finger of time, and the remembrance of 
which calls np the most grateful and pleasing associa- 
tions ; to yon we owe all the happiness of a well-spent 
life. In sickness or on the bed of death no one can watch 
over us with the care and solicitude of a mother, wife or 
sister. Your words of kindness and sympathy cheer 
and comfort us in our afflictions ; your fair hand can 
smooth the sick pillow or relieve the aching brain better 
than any other. Through your influence the hour of 
trial and suffering is made to pass as a shadow, misfor- 
tune becomes like golden sunshine, and the pangs of 
adversity yield to your smile and affection ; you cause 
man to view the dangers and terrors surrounding him as 
momentary clouds floating by, and guide him onward 
in the road to virtue and happiness ; you are man's 
harbor of safety and contentment, his richest treasure, 
Heaven's best gift, and the link that binds man forever 
to his Creator. You have done much to reform and 
civilize the world, and while I entreat you not to relax 
your noble efforts in any of your works of piety, philan- 
thropy or temperance, I plead of you to strike quick and 
heavy blows at the head of the monster sin of opium 
eating. If a great reform is not effected in this thing 
soon it will be absolutely necessary for legislation to 
come between opium and its victims, so rapidly is the 
fatal practice increasing. 

Opium, like alcohol, is a remedy of no mean import- 
ance, and when indicated its place can not be supplied 



a:n"d guide to health. 83 

by anything else. "When I speak of opium I will be 
understood to include all of its preparations, such as 
laudanum, morphine, &c., &c. Its antidote, when taken 
in an over-dose, are (after the use of the stomach-pump 
or a brisk emetic of a large tablespoonful of ground 
mustard in a half pint of warm water, repeated until 
the contents of the stomach are discharged) : brandy, 
ammonia, strong coffee, or camphor and musk, in con- 
nection with external stimulants, such as cold affusion, 
loud talking to the patient, compelling him to walk be- 
tween two assistants and applying aq. ammonia (harts- 
horn) to the nostrils. 

I have not given the remedial effects of opium upon 
the system, but will again remark that opium, when 
indicated and properly used, is one of the very best 
articles belonging to the materia medica. It is generally 
used for its anodyne effects. 

Below I give an extract from a New York paper which 
will give a faint idea of the extent of the use of the drug 
in that city. A few days ago I saw an article in one of 
our St. Louis papers giving some statistics showing to 
what a fearful extent it was used in this city — several 
hundred dollars worth every week were sold to the regu- 
lar " eaters." It is strange, indeed, that rational men 
and women will act so unwisely in a matter that so 
directly interests them as the preservation of their health. 
I certainly think that it is chargeable to the lamentable 
fact that they know so little of the laws of health and 
life. When they begin to understand these a change 
may be expected. 

" Opium Eating in New York — Its Fearful Extent — 
Ladies Using Opium. 

" The use of the pernicious drug is not confined to the 
men ; there are hundreds and thousands of women who 



84 THE FAMILY PHYSICIAN 

are in the daily habit of intoxicating themselves with it, 
and they are found in all grades of society, but chiefly 
among those who are not dependent upon their own 
exertions for their support. Some of the drug stores up 
town and in Brooklyn sell more opium to women than to 
men, the latter buying chiefly at the down town shops. 
ISTot long ago a lady of one of the first families was 
arrested on the street for drunkenness and locked up in 
one of the station-houses. She had all the appearances 
of being intoxicated, and the police very naturally con- 
cluded that she was of the fair but frail class, and 
the best thing to do with her was to lock her up. It 
turned out on investigation that she was wholly innocent 
of having swallowed fusil oil or any thing of the sort, 
but had only been indulging in opium. The affair was 
hushed up, and the n^me of the lady did not appear in 
print. Two or three cases like this have occurred, and 
some of the police say that they have made several 
arrests under the mistaken impression that their subjects 
were suffering under too heavy stress of whisky. 

"Very few of the ladies who use opium venture into the 
street while under its influence, and the fact that these 
arrests occur in public shows that the habit is very 
wide spread. Many of those addicted to it conceal the 
fact from their nearest friends, while others are in the 
habit of meeting in little parties and having a social 
chew, just as some of the ladies down South used to 
indulge in social " dips." Opium takes the place of 
snuff, and the parties generally get up to a high pitch of 
enthusiasm. As opium does not lead to a head-breaking 
and combative intoxication, like whisky or other strong 
drink, the fair creatures do not, save in rare cases, disturb 
their neighbors while at these opium seances. An 
exception is sometimes found; there was one a few 



AND GUIDE TO HEALTH. 85 

months ago, when the female inmates of a house on 
Fourteenth street fell to pulling each other's hair and 
committing other breaches of propriety while under the 
influence of opium. But then it must be remarked that 
they were not, at best, the possessors of good character. 

" OPIUM AMONG MEN. 

" Men make less concealment of the opium habit than 
women, and from their more frequent mingling in busi- 
ness affairs they are more liable to detection. I know 
several men in business who are in the habitual use of 
opium, and generally carry neat little lumps in their 
pockets. The use of the drug gives them a certain ner- 
vousness of manner, which is probably the first sign to 
be discovered. Any metropolitan reader of this can 
probably call to mind from one to half a dozen men he 
has met whose manner indicated that they were no 
strangers to opium. I know two editors "who use a great 
deal of the drug ; one has not yet impaired his faculties 
with it, though he will do so before long ; the other has 
taken so much of the narcotic that his brain is stupefied 
and his thoughts often wander. Still he writes well and 
often brilliantly, and none who read his productions 
would imagine that they came from a head that is fre- 
quently more than two-thirds insensible, while the body 
to which it belongs is in full activity. — ' Waterloo's ' 
New York Letter to the Rochester Chronicle" 



86 THE FAMILY PHYSICIAN 



ABSINTHE. 



It would seem that quite enough death and destruc- 
tion could Tbe found in alcohol and opium. But the 
people are restless and impatient and seem determined 
to exhaust the resources of science in trying to find an 
article to destroy body and soul, hence a new drink has 
been made which is called "Absinthe." It takes its 
name from the Artemisia Absinthum or common worm- 
wood (this belongs to the fish-berry class) ; absinthe 
is the French name. The properties of this plant are 
stimulant, tonic, narcotic, sedative, and are said by 
some to be anthelmintic. In over-doses it produces 
insensibility, convulsions and foaming at the mouth. 
This is a beautiful drunk. The only merit absinthe 
seems to have over alcohol or opium is, that it seems to 
destroy the mind in much shorter time than either of 
the others, or in fact than both combined. Absinthe is 
another drink that is used mostly by those in high life, 
and particularly by the ladies, who soon become fasci- 
nated with it, lose all power of control over themselves 
and soon become miserable wrecks, and are only glad 
to escape from their wretchedness and shame by death. 
Ladies, beware of this viper. 

I give below an extract from a New York paper pub- 
lished a few days ago : 

"Absinthe Drinkers. 

"It is alarming the extent to which absinthe is coming 
to be used in this metropolis. Most of the bars retail it 



AND GUIDE TO HEALTH. 87 

out in the same manner as they do bourbon. Young 
and old go out to drink, and when one calls for a whisky 
cocktail another will order absinthe. One of the most 
brilliant writers of the New York press has nearly ruined 
himself, physically and intellectually, by the use of 
this pernicious sedative for only a year and a half. 

" I saw the other day a talented lady, the wife of one 
of the most prominent professional men of this city, who 
has nearly lost her reason by the use of absinthe. She 
first took it to allay pain ; she now takes it to allay 
appetite. Her self-control is entirely gone. She totters 
upon the brink of the grave, looks forward with joy to 
death, and frequently undertakes to put an end to her 
mental sufferings. A beautiful home, loving husband 
and fine children, together with all the enjoyments which 
wealth and refinement can bestow, are not sfficient to 
deter her from indulging in this soul-and-body-destroy- 
ing drug. 

" The effects of absinthe seem to be swifter and more 
fatal than those of either opium or morphine. It obtains 
an all-powerful control over its votaries, deadens the 
sensibilities, and is, indeed, the ' guillotine of the soul.' " 



88 THE FAMILY PHYSICIAX 



TOBACCO. 



The use of this pernicious weed has become so preva- 
lent in this country that in some places a large majority 
of "both sexes above the age of ten or twelve years nse it. 
The same habits prevail to a great extent in almost every 
portion of the globe. 

TThen we take into consideration the disagreeable and 
repulsive character of this filthy article to the unvitiated 
palate, it is truly surprising that it ever should have been 
thought of as an article for such use at all ; and when to 
this consideration is added the exceedingly important 
one that it is highly injurious to the human system, the 
fact of its general use becomes still more astonishing. 
Many, however, are not aware of its pernicious effects, 
but none are unacquainted with its filth. 

It is said that three drops of the distilled oil of tobacco 
dropped upon a cat's tongue will destroy its life in fire 
minutes, and, in many instances, it is also said, that its 
use internally, and even externally, has caused death in 
a very few minutes. A tobacco poultice applied to the 
pit of the stomach will quickly produce vomiting. 

Old Dr. Darwin says, " The universal custom of chew- 
ing and smoking tobacco for many hours in the day not 
only injures the salivary glands, producing dryness in 
the mouth when this drug is not used, but I suspect it 
also produces scirrhus of the pancraes. The use of to- 
bacco in this immoderate degree injures the power of 



AND GUIDE TO HEALTH. 89 

digestion, hj occasioning the patient to spit out that 
saliva which he ought to swallow ; and hence produces 
that flatulency which the vulgar unfortunately take it to 
prevent." 

But smoking and chewing not only carry off the 
necessary saliva from its proper place, they likewise 
saturate the tongue and mouth with tobacco juice, 
thereby vitiating the saliva that remains, which in this 
pernicious and poisonous condition finds its way to the 
stomach. \Vho, in view of these considerations, can 
wonder that tobacco fixes its deadly grasp upon the 
organs of vitality, gradually undermining the health 
and sowing the seeds of disease, which are seen, sooner 
or later, to take root and spring up, carrying away its 
victim. It seems, says a good writer, to act directly 
upon the nervous system, enfeebling, exhausting, or 
destroying the powers of life. 

Instead of preserving the teeth from decay, as many 
suppose, the chewing of tobacco wears down or absorbs 
the grinding surface of the teeth much faster than would 
otherwise be the case. So active a poison as the smoke 
or juice of tobacco continually in contact with the 
surface of the teeth must tend to destroy their vitality, 
and, consequently, to hasten instead of retarding their 
decay, while either turns them black and makes them 
look filthy. 

It also produces a husky dryness of the mouth, 
creating a thirst which, in many cases, is not satisfied 
short of alcoholic drinks. In this way the use of 
tobacco often leads to that soul blighting curse — drunk- 
enness. To this dark catalogue may be added the turbid 
nostril, the besmeared lip, the squirting of filthy saliva 
upon the floor, furniture, carpets, and even upon the 
clothes of those around you ; and last, though not least, 



90 THE FAMILY PHYSICIAN 

the foul and offensive breath, which to those whose sense 
of smell has not been perverted is almost insupportable. 

The nse of tobacco is a needless waste of money — nay, 
worse than throwing it into the ocean, where it would at 
least do no harm. 

Tobacco is not useful in any form as a medicine ; it 
has been frequently used in the form of an ointment or 
a poultice, but in either preparation its action often goes 
beyond your expectations, and has been known to pro- 
duce death. The evil in the use of alcoholic drinks and 
opium is in their abuse, as both are excellent therapeutic 
agents when indicated, but the evil of tobacco is in its 
use at all. 

In the Christian Pioneer there is an excellent article 
from a pious lady. The journal is published at Chilli- 
cothe, Mo., edited by Elder D. T. Wright : 

"A Protest 

" A • sister ' sends us a protest against the use of 
tobacco in houses of worship. She is engaged in a good 
cause and has the sympathy of the sisterhood and of 
every truly refined man. 

" ' There is an evil which I have seen under the sun, 
and it is common among men.' The evil of which we 
speak is tobacco cliewing in cliurch. Much has been 
said by our ministers concerning this offensive practice, 
but to little or no purpose. Possibly the remonstrance 
of the sisters may have some effect. 

" We enter a house of worship and approach a seat by 
the stove. Here we find the floor in a horrible condition, 
the effect of tobacco made use of by brethren who have 
previously warmed themselves there. The house be- 
comes filled and the brethren vacate their seats to 
accommodate the sisters with a seat ; but here we find 



AND GUIDE TO HEALTH. 91 

such pools of tobacco spittle upon the floor that we feel 
more inclined to stand than to bring our clothing in con- 
tact with the filthy floor by seating ourselves. Imagine 
our consternation when, by accident, a handkerchief or 
glove falls upon the floor ! By a little observation we 
see here and there a brother incline the head and eject 
from his mouth a fresh installment to the defilement 
already upon the floor of the house of God. Brethren, 
we are fully persuaded that such things ought not to be. 
What would you think if the sisters were to indulge 
their appetites by eating cakes and apples during the 
time of worship ? Is there more impropriety in gratify- 
ing a relish for food on such occasions than there is in 
gratifying a relish for tobacco ? ' Have ye not houses to 
eat and drink in, or despise ye the church of God V 

" If brethren are so enslaved to the use of tobacco that 
they can not abstain from its use during the hours of 
worship, we advise them, if they believe there is any 
efficiency in prayer, to imitate the example of one of 
whom we have read, who, finding himself unable in his 
own strength to quit the use of tobacco, prayed for help 
and became a freeman. 

" Brethren, we are in earnest in this matter. It has 
been a source of great annoyance to us, and if you cannot 
look upon the subject in the same light that we do, pray 
have charity for the ' weaker vessels,' and, according to 
the divine injunction, ' Give none offense in anything.' 

" We are aware that there are many brethren to whom 
these remarks do not apply, yet we know that there are 
those to whom they do apply, and to such we submit 
this christian protest." 

In addition to this christian " protest," I would earn- 
estly appeal to all who use this filthy and pernicious 
article to desist. First, because you have no right to 



92 THE FAMILY PHYSICIAN 

contaminate the air that others must breathe with tobacco 
smoke and the disagreeable stench arising from the filth 
that you eject from your mouth. Second, because you 
have no right to saturate a floor or carpet that others 
must use. Third, for the sake of your health, that must 
be materially injured by it. Fourth, for the sake of 
your pocket, which must be considerably depleted by the 
purchase of the article. Fifth, for the sake of your 
time. Sixth, for the sake of your friends, who can not 
fail to be pained in your company. Seventh, for the sake 
of your voice. Eighth, for the sake of your memory, 
that it may be vigorous and retentive. Ninth, for the 
sake of your judgment, that it may be clear and correct 
to the end. Tenth, for the sake of your soul — do you 
not think that God will visit you for your loss of time, 
waste of money and needless self-indulgence? Have 
you not seen that the use of tobacco leads to drunken- 
ness f Do you not know that habitual smokers have the 
drinking vessel often at hand ("the glass of lager") and 
frequently apply to it, nor is it any wonder, for the great 
quantity of unnecessary moisture which is drawn off 
from the mouth, &c, by these means must be supplied 
in some way. You tremble at the thought, 'and well 
you may, for you are in great danger. Then is it strange 
that a Turkish Emperor, or a Russian Czar, or a Persian 
King should forbid its use on pain of death ? — mitigated, 
it is true, in the case of snuff taking by merely having 
the nose cut off. Nor is it strange that Pope Urban 
VIII. made a Bull to excommunicate all who used to- 
bacco in churches. 

But if all other arguments fail to produce a reforma- 
tion in tobacco consumers, there is one which is ad- 
dressed to good breeding and benevolence, which for the 
sake of politeness and humanity should prevail. Con- 



AND GUIDE TO HEALTH. 93 

sider how disagreeable your custom is to those who do 
not follow it. An atmosphere of tobacco effluvium sur- 
rounds you wherever you go ; every article about you 
smells of it — your apartments, your clothes and your 
breath. Nor is there a smell in nature more disagree- 
able than that of stale tobacco arising in warm exhala- 
tions from the human body, rendered still more offensive 
by passing through the pores and becoming strongly 
impregnated with that noxious matter which was before 
insensibly perspired. It is loathsome to the eye, hateful 
to the nose, harmful to the brain, dangerous to the lungs, 
and in its black, stinking fume nearly resembles the 
horrible stygian smoke of the pit that is bottomless. 



94 THE FAMILY PHYSICIAN 



BATHS-BATHING. 



TUEKISH BATH. 

The preservation of health depends to a very great 
extent upon cleanliness. The sympathetic relations 
which exist between the skin and internal organs, as the 
kidneys, Tungs and liver, are very great, and, as a conse- 
quence, whenever the functions of the skin are interfered 
with, whether from exposure to sudden changes of tem- 
perature or from the accumulation of filth, these internal 
organs and many others suffer in proportion. The skin 
possesses a nervous system which renders it sensible to 
all external impressions, which are readily transmitted 
from it to the brain, through the agency of the nerves ; 
it is, likewise, endowed with a system of blood vessels 
which play a very important part in the animal economy. 

Besides these there is contained within the skin 
numerous minute tubes, spirally and irregularly coiled 
upon themselves, each of which is in close proximity 
to one of these capillary blood vessels, which separate 
the perspiration from the blood in the capillaries. 
These perspiratory organs discharge the perspiration 
externally through a minute mouth or pore, which, under 
ordinary circumstances, passes off in the form of vapor, 
being termed insensible perspiration; but when the 
system is over-heated by exercise, increased heat or 
mental excitement, the perspiration is thrown off in such 
large quantity as to form a watery fluid upon the surface 



AND GUIDE TO HEALTH. 95 

of the "body, winch is called sensible perspiration. 
(" sweat.") 

It is estimated that there are 3528 perspiratory pores in 
each square inch of skin on a human being. Now each 
of these pores being the aperture of a little tnbe about 
a quarter of an inch long, it follows that in a square 
inch of skin there exists a length of tube equal to 882 
inches, or 73 1-2 feet. Now the number of square inches 
of surface in a man of ordinary height and bulk would 
be about 2500 ; the number of pores, therefore, would be 
7,000,000, and the number of inches of perspiratory tube 
1,750,080— that is, 145,833 feet, or 48,600 yards, or nearly 
28 miles. Surely such an amount of drainage as 28 
miles in the human skin is a consideration of no mean 
importance. What if this drainage were obstructed by 
filth or otherwise ? Could less be expected than a de- 
rangement of such organs as the lungs, liver and kidneys, 
and, in fact, may we not readily expect to find the crim- 
son fluid of life contaminated and poisoned ? Could we 
have a stronger argument for enforcing the necessity of 
attention to the skin ? 

Besides the perspiratory organs, the skin is also pro- 
vided with sebaceous or oil glands, which, although 
resembling the perspiratory glands in their organization, 
are more complex and are not so uniformly disseminated 
over the body ; being found over the nose, certain parts 
of the face, ears, &c, and wherever hair is present, 
while on the palms of the hands and soles of the feet 
they are absent. These glands secrete an oily matter 
which protects the skin from the influence of fluids with 
which it is apt to be bathed, also from an undue action 
of the sun and atmospheric changes, keeping the hair 
and its roots in a soft, pliable condition. But when from 
any cause the functions of the skin is sluggishly per- 



96 THE FAMILY PHYSICIAN 

formed, tlie fatty matter instead of being discharged 
upon the skin is retained in the oil dnct, where it con- 
cretes into a matter of the consistence of cheese ; the oil 
tube becomes gradually enlarged "by the fresh deposition 
of oil-globules, and at its mouth will be eventually 
observed a black point, which those on whom it forms 
are in the habit of squeezing out, supposing the mass of 
fatty matter to be a worm. Although not a worm the 
microscope has discovered to us that it contains animal- 
cules, of elongated form, from about the one hundred and 
thirtieth to the fortieth of an inch in length, having an 
obtuse head which is directed inward. The}^ are met 
with in groups of from two to twenty, increasing with the 
inactive state of the skin, and diminishing as it arrives 
at a normal activity. 

Perspiration is mixed with the above oily and other 
matters ; it has an acid smell and reaction, which is 
owing to the presence of lactic or acetic acid, and con- 
tains about from one-half to one and a half per cent, of 
solid matter, consisting principally of animal matter, 
with some saline substance discharged from the serum 
or watery portion of the blood. "When these perspira- 
tory matters are permitted to remain in contact with the 
skin for any length of time they rapidly decompose, 
lessen the activity of the skin, causing skin diseases, 
and contaminate the surrounding atmosphere, which, 
when confined, will occasion fevers and other maladies, 
often of a dangerous character ; and, undoubtedly, many 
lingering disorders are thus occasioned, especially of the 
lungs, kidneys and liver. The greater the obstruction 
to the exhalent action of the skin the greater the liabil- 
ity to serious disease, and when it is checked the blood 
becomes imperfectly aerated, the temperature of the body 
is rapidly reduced, and death soon ensues. From the 



AND ttUIDE TO HEALTH. 97 

above statements will be seen the vast importance of 
keeping the skin clean and healthy, in order that it may 
properly perform its functions. A person with a clean, 
healthy skin preserves a greater amonnt of health, of 
good feeling, of pleasant disposition, of proper nervous 
action, cheerfulness and piety than he possibly can if 
the skin is neglected and filthy ; he feels if his skin is 
clean and in good condition that he is " sound all over," 
while a filthy or diseased skin is a source of constant 
annoyance to its possessor and all who are associated 
with him. 

The Turkish Bath is certainly a course of the most 
thorough cleaning I have ever seen ; the process is one 
which, while it is the most pleasant, is at once the most 
thorough known to man. The people of St. Louis are 
most fortunate in having an institution of this kind at 
No. 410 Market street, fitted up by Prof. "William Rober- 
son precisely on the Oriental plan, with an eye to the 
comfort and welfare of those who have the good judg- 
ment to avail themselves of this beneficiary luxury. 
The writer of this article has just come fresh and cheer- 
ful from one of Prof. K-.'s Turkish baths, and feels it a 
duty to recommend them to all who are situated so they 
can have them. The process is simple and practical in 
the extreme. You are first taken into a dressing-room 
where you are divested of your clothing, you are then 
taken to a room filled with hot air by means of a furnace, 
say to a temperature of 130 ° Fah. ; here, upon entering, 
your head is well sponged with tepid water, then you 
are wrapped in a sheet and laid on a reclining bamboo 
chair, where you remain for from ten to twenty minutes, 
or until perspiration begins ; you are given a sponge wet 
with cold water and directed to sponge your face occa- 
sionally, which relieves you of any sense of oppressive 



98 THE FAMILY PHYSICIAN 

heat. After remaining here as above stated yon are then 
taken to an adjoining room, kept about 30 degrees warmer 
than the first, where yon Ibegin at once to sweat profnsely ; 
yon are kept here ten or fifteen minntes and then taken 
to the bathing or shampooing room. In the bathing 
room yon are placed on a marble slab or large table and 
rnbbed by the attendant from head to foot, kneaded and 
treated to a " right smart chance of slapping," which is 
done by the Turkish condnctor at Prof. Roberson's in 
the most scientific manner, inviting the blood most cor- 
dially into the capillary vessels. Then yon are most 
thoroughly washed with warm water and soap and again 
rnbbed and slapped, yonr joints worked and rnbbed, &c. 
From the table yon are pnt nnder a shower bath of 
moderately cold water where yon are most thoronghly 
rinsed, then yon are pnt throngh a light process of towel- 
ing and wrapped in a sheet and taken to the " cooling 
room " where yon are left to cool off and enjoy the happy 
consciousness that yon are externally at least most 
thoroughly clean. 

If this simple process were practiced by every one 
once a week, skin diseases and many organic diseases 
wonld soon disappear from the list altogether. 

Thns far I have spoken of the Turkish bath as a pre- 
ventive of skin and other diseases ; in this respect it is 
valuable, but its usefulness does not end here by any 
means. In the treatment of a very large class of diseases 
the energies of the physician must necessarily be directed 
to the skin as auxiliary. 

There certainly is no bath that will more thoroughly 
cleanse the surface than the Turkish bath. 

SPIEIT VAPOR BATH. 

The spirit vapor bath, or hot air bath, was " first intro- 
duced to the notice of the profession " by Prof. John 



AND GUIDE TO HEALTH. 99 

King, of Cincinnati, about a quarter of a century ago. It 
soon grew into popularity, and still stands deservedly 
high as a preventive of disease, and as an auxiliary in 
the treatment of many forms of disease, particularly of 
the skin. It is so simple and the mode of its administra- 
tion is so easy that it recommends itself to the public, 
particularly in localities where the Turkish bath can not 
be had. As regards its administration the process is so 
simple that any one can take it, even without an assistant.. 
The patient is undressed and seated on a wooden-bottomed 
chair or stool, so that the heat shall not strike him 
directly as it issues from the burning spirits. After seat- 
ing himself a large blanket is thrown around him from 
behind, covering the back part of his body, and also the 
chair on which he sits, and is then pinned in front; 
another blanket is passed around him in front and pinned 
behind, and thus the body is so completely covered that 
the escape of the heat is prevented. A saucer contain- 
ing about two tablespoonfuls of whisky or alcohol is 
placed upon the floor, under the chair, and lighted, by 
touching to it a piece of burning paper, then drop the 
part of the blanket that has been raised and allow the 
spirit to burn until it is consumed, taking care that the 
flame does not burn the blanket. As soon as the spirits 
are consumed entirely and the flame extinguished add 
the same quantity of spirits and again ignite ; continue 
until the patient perspires freely ; this will be in Unq or 
ten minutes, as a general rule.. During this process the 
patient's face should be occasionally sponged with cold 
water. 

As soon as the body and limbs become well bathed in 
perspiration the blankets may be removed and the whole 
surface sponged freely with water a little warm, to which 
has been added soda or saleratus enough to make it 



100 THE FAMILY PHYSICIAN 

feel a little " slippery." After this is done the whole 
surface should Ibe rinsed with moderately cold water and 
"briskly dried with a soft towel. In this manner the skin 
will be cleansed and tone restored to the relaxed "blood 
vessels, and by fixing an increased amonnt of blood in 
its cell structures, a more vigorous capillary circulation 
established. 

The spirit vapor bath is useful in all skin diseases, colds, 
febrile and inflammatory attacks, recent amenorrhcea and 
dysmenorrhcea, and sometimes in supended lochia and 
many of the inflammatory attacks during the puerperal 
period. It should not be administered to those who have 
great weakness of lungs, in whom the process of decar- 
bonization of the blood goes on imperfectly, or it will 
be attended with injurious consequences. 

VAPOR BATH. 

This is one of the old institutions, and a very useful 
one, too, but it is so well known that a description of it 
would seem hardly necessary. From this bath the 
name " steam doctors " was given to Thompson and 
his school. As much as it has been derided by the 
"regular profession" and their advocates, it has done 
an immense amount of good, and is an institution that 
ought to be perpetuated. It is administered just like 
the " spirit vapor bath " above described, only the steam 
is generated with an apparatus in which water is boiled 
by means of a spirit lamp, or from a vessel containing 
water placed under the chair in which hot bricks, stones 
or smoothing irons are immersed. The time required to 
produce perspiration is from ten to twenty minutes. 
You must not mistake the vapor that settles on the body 
and limbs for perspiration. The head and face should 
be wet with cold water at the commencement of the 



AND GUIDE TO HEALTH. 101 

operation and repeated frequently during the process ; 
this will prevent unpleasant faintness or fullness of blood 
in the head. After the desired amount of sweating is 
had the same plan will be applicable in this as above 
recommended in the " spirit vapor bath," i. e., the wash- 
ing and rinsing. It was, however, the custom to take 
the patient from the chair still wrapped in his blankets 
and place him in bed with them still around him, and in 
addition to this place jugs of hot water or hot bricks or 
stones to his feet and knees and allow him to remain in 
this condition for hours, drinking hot teas, &c. Such a 
course, however, is only calculated to further exhaust a 
patient without even the promise of any benefit. This is 
the feature no doubt that has caused the once famous 
vapor bath to fall comparatively into disuse. 

THE DOUCHE. 

This consists in a stream of water, varying in size from 
half an inch to two inches in diameter, and having a fall 
of some feet. In domestic practice it can be performed 
by pouring water from the spout of a tea kettle held 
some distance above the patient, refilling the kettle when 
empty, until the process has been continued for a suffi- 
cient length of time. This form of bath is especially 
adapted to the treatment of sun stroke ; in fact it can 
scarcely be successfully treated without it, and should 
never be omitted as one of the earliest appliances to the 
head and spine. The douche is not a form of bath I 
would recommend for general use ; injury may be occa- 
sioned by its injudicious employment. 

foot bath (Pcedaluvium). 

This bath is so common and so well understood that a 
description of it is almost unnecessary. A vessel is filled 
with water as hot as it can be comfortably borne and the 



102 THE FAMILY. PHYSICIAN 

feet immersed in it ; salt or mustard may "be added to 
the water. Trie feet should usually remain in the bath for 
ten or fifteen minutes, and when they are taken out must 
be rubbed dry with a towel and then clothed or wrapped 
up so as to keep them warm. Simple as this form of 
bath is it is of incalculable value as an auxiliary in the 
treatment of many diseases. It should always be prac- 
ticed when the feet are unduly cold. " Keep the head 
cool and feet warm " is an old adage, and gives a rule of 
perhaps as much real importance as any adage ever 
spoken in regard to health. This rule is sadly neglected 
by females. How often do they permit their feet to remain 
cold for hours, and even days, going to bed at night with 
them as cold as they would be in death. Such a practice 
as this, my fair friends, will soon cause the bloom of 
health to fade from your cheeks and the dark, tell-tale, 
black ring to encircle your once sparkling eyes. If 
you have been guilty, as above " charged and specified," 
never, after you have read this paragraph, again retire 
to your couch to attempt to sleep with cold feet ; it will 
not be much trouble to take a foot bath, or if this be quite 
out of the question, at least place a hot brick or two to 
your feet. 

SHOWEE BATH. 

This is another form by which water, either warm or 
cold, may be applied to the body. A vessel may be per- 
forated in such a manner that the water is permitted to 
escape in small streams, and rapidly descend upon the 
person and completely drench him, imparting, if cold, a 
powerful shock to the system. Prof. J. King says " the 
effects produced by a cold shower bath upon many per- 
sons of strong constitution, as well as upon the delicate 
and those of extreme nervous sensibility, are so severe 
and disagreeable that its application under ordinary cir- 



AND GUIDE TO HEALTH. 103 

cumstances would be very improper. I believe," says 
the doctor, " that the sudden application of cold water to 
the system, continued daily or frequently repeated, is 
very seldom beneficial, and is more frequently a cause of 
disease than is supposed. It is apt to occasion a subse- 
quent depression, languor, headache, and in the plethoric 
apoplexy. It should not be used when disease of some 
internal organ exists." I have quoted this from Prof. 
King, not that I endorse the whole of it, but that persons 
who use the shower bath may do so with proper caution. 
For my part I deem it a luxury in "hot weather," and 
have never seen any bad results follow its use. Dr. 
King recommends a tepid shower bath (to which the 
above objections do not apply) once, twice or thrice a 
week. 

A shower bath should be so arranged that the water 
will descend rapidly and be soon discharged; and im- 
mediately after the drenching the person should dry 
himself with a towel not too rough. The former custom 
has generally been to use a great deal of friction with 
rough, coarse towels. This is a practice I never would 
subscribe to ; this rough process often breaks the firm 
cuticle and destroys what nature intended for our benefit. 
A moderate amount of quick rubbing is quite necessary, 
but it should not be too hard, and above all should not 
be done with the coarse, rough towels that we often find 
around our bath houses. 

BATH BY IMMERSION. 

This is a very good plan, but certain rules are neces- 
sary to be observed in order to prevent any mischievous 
effects. The water must be of a temperature adapted to 
the patient. Should a chilly sensation be experienced a 
few minutes after entering, the water is too cold ; the 



104 THE FAMILY PHYSICIAN 

proper temperature will occasion a refreshing sensation. 
Moderate exercise must be taken shortly previous to 
plunging into the water, but this exercise should not be 
sufficient to fatigue or cause copious perspiration. The 
person should remain in the water until the bathing is 
finished, but this should not be too long. Five minutes 
is generally long enough to remain in the bath. The 
water should be neither hot nor cold, but for general use 
a temperature of from 85 ° to 95 ° Fahrenheit is prefer- 
able, and taken altogether is the most useful. 

As soon as the individual " comes up out of the 
water " he should be at once quickly dried by rubbing 
briskly with a towel, and if he does this himself he 
gains another advantage, i. e., by the exercise which 
assists the reaction that is so necessary. 

SPONGE BATH. 

This form of bathing can be of the most general appli- 
cation, and should be resorted to in the absence of the 
other modes at least every other day "the year round" 
by every man, women and child. 

There is no excuse for neglecting personal cleanliness ; 
let your position in life be ever so humble or your spare 
time ever so limited you can find time enough two or 
three times a week to devote five minutes to personal 
cleanliness. Cleanliness is next to godliness. Procure 
yourself a sponge, or if you have not the means to pro- 
cure a sponge get an old towel or other bit of old cloth, 
or if you can not do this get two or three pints of water — 
God has given you that — and use the hands that he has 
also given you to wash the whole surface of your body. 
This ought to be repeated by every one once a day, and 
should by no means be neglected. 

I know it is the custom of some persons to seldom if 



AND GUIDE TO HEALTH. 105 

ever bathe. I have known persons who were not wet 
" all over " once a year except by sweat or nnless they 
were canght out in a rain storm. A stench would come 
up from their very clothing almost unbearable. Such 
persons rob themselves of a great luxury and the enjoy- 
ment of good health, while they subject those who have 
to come in close contact with them to a very great annoy- 
ance. Can a man's heart, conscience and character be 
preserved pure while his body is a mass of stinking 
filth ? Can a man be an acceptable Christian who 
neglects personal cleanliness ? The very crowning act in 
the obedience of the gospel of Jesus Christ, and the one 
that changes a man's state — that takes him out of the 
kingdom of darkness and places him in the kingdom of 
light — the kingdom of God's dear Son, is performed in 
water, and ought to suggest cleanliness to the minds of all. 
Nature revolts at the idea of filth ; it is, unquestion- 
ably, a great source of human misery and disease. 
From filth arises our dangerous epidemics. Cholera, that 
terror to the human race, took its rise in the delta of the 
Ganges from filth ; it has ravaged every country on the 
globe, disseminated by filth, carrying destruction and 
dismay every where. To enumerate the diseases and 
woes to the human family by filth would transcend my 
bounds. All skin diseases have their origin in a filthy 
condition of the skin. The minute vessels called the 
pores become obstructed by an accumulation of matters 
that ought to have been washed off, and disease is the 
consequence. In short, cleanliness is one of God's laws, 
and can no more be violated with impunity than can his 
law of gravitation. Who would expect to fall from the 
top of a three-story house without injury, thus viola- 
ting the law of gravity ? Who can expect to violate the 
laws of cleanliness and not suffer a severe penalty? 
As certainly as the peal of thunder follows the flash of 
lightning will the penalty for filth come. 



106 THE FAMILY PHYSICIAN 



AMTOMY AID PHYSIOLOGY. 

A CONDENSED REFERENCE. 



OUTLINES. 

It is my design under this head to give a brief outline 
of the structure and organs of the body. "Within the 
compass of this work it will not be possible to enter to any 
great extent into detail, but enough will be presented to 
give the reader a general knowledge of Anatomy and of 
the organs which constitute the human system. As far 
as the use of technicalities are concerned, in giving the 
names of many of the bones and other parts, I have to 
use them here, as I know no other names, and these 
names are arbitrary and express the use, shape, &c, &c. 
But I will try to explain them so that no one will fail to 
understand. 

THE SKELETON 

Is divided into the head, trunk and extremities. 

EIGHT BONES OF THE SKULL. 

I 

Os Frontis. — This bone constitutes the forehead. 
Ossa Parietalia. — Sides of the head above the ears. 
Os Occipitis. — The back and lower portion of the skull. 
Ossa Temporum. — Bones of the temple. 
Os Ethmoides. — Bones situated between the root of 
the nose and the brain. 

Os Sphenoides. — The base of the skull. 



AND GUIDE TO HEALTH. 107 

FOURTEEN BONES OE THE FACE. 

Ossa Maxillaria Super lor a.— The two bones of the 
upper jaw. 

Ossa Malar um. — Cheek bones. 

Ossa Nasi. — The two bones which form the arch of the 
nose. 

Ossa Laclirymalia. — Situated within the inner angle 
of the eye. 

Ossa Palatina. — In the posterior portion of the roof 
of the month. 

Ossa Turbinata. — Interior bones of the nostril. 

Lifer lor Maxillary. — Lower jaw. 

Os Vomer. — Partition of the nose. 

THE TEETH. 

In the adult there are thirty-two teeth, consisting of 
eight incisors or front teeth, four cuspidetes or eye teeth, 
eight bicuspides or small double teeth, eight molar es or 
large double teeth, and four sapiential or wisdom teeth. 

THE TONGUE 

Contains one bone, which resembles in shape the letter U 
and is termed the os Jiyoides. 

EIGHT BONES IN THE EAE. 

Malleus, Incus, Stapes and Orbicularia. 

FIFTY-FOUR BONES IN THE TRUNK. 

Twenty-four of tlie Spine. — Termed vertebrse. These 
are divided into seven cervical, twelve dorsal and five 
lumbar vertebrse ; one sternum or breast bone. 

TWENTY-FOUR RIBS, 

Of which the five lower ones are termed, false on each 
side, and the seven upper ones true. 



108 THE FAMILY PHYSICIAN 

FOUR BONES OF THE PELVIS. 

The sacrum and coccyx behind on the median line, and 
the two ilia on each side uniting before. 

SIXTY-FOTTK BONES OF THE UPPER EXTREMITIES. 

Olavicula or collar bone, scapulas or shonlder blade, 
ossa humeri, bones of the arm between the shonlder and 
elbow, two ulna and two radii bones between the elbow 
and wrist. In each wrist or carpus are eight bones, in the 
palm of the hand are five metacarpal bones, and twenty- 
eight form the fingers, termed collectively phalanges. 

SIXTY BONES OF THE INFERIOR EXTREMITIES. 

Ossafemoris, thigh bones ; patella?, knee bones ; fibula?, 
ontside bones between the knee and ankle ; tibia, bones 
of the shin, two of each. At the instep are five bones — 
os calcis, or heel bone ; os astralagus, part of the ankle 
joint; os cuboides, square bone ; os nabiculare, bone re- 
sembling a boat, and os cuneiformia, wedge-like ; ten 
metatarsi, or foundation of the toes. 

In the toes twenty-eight phalanges — Sesamoides, or 
bones occasionally found in the feet and hands, number- 
ing eight. Total number of bones, 251. 

THE MUSCLES. 

It is difficult to give the exact number of the muscles, 
as different standard works do not agree as to the num- 
ber ; this arises from the fact that they do not agree as 
to what are in reality muscles, some denominating parts 
as muscles that others do not. The number may be set 
down at about 500. They are sometimes divided into 
voluntary and involuntary. The voluntary muscles act 
in accordance with the will, and it is by these we are 
enabled to command our movements, as walking, danc- 
ing, leaping and in moving various parts of the body. 



AND GUIDE TO HEALTH. 109 

On the contrary, over the others the will exercises no 
control, as, for instance, the will possesses no power 
over the muscular action of the heart. 

The muscles consist of fibres disposed of in bundles, 
which are easily distinguished with the eye ; these are 
divisible into smaller ones, and again are capable of 
being divided into smaller, &c. The fleshy snbstance is 
the muscular portion. 

The muscles by which the arm or leg is made to bend 
are termed flexors, and those which exercise an antagon- 
istic influence or opposite action, extensors. 

That portion of a muscle which is attached to a part 
the most fixed is the origin, so termed, and that which 
is affixed to a part more movable, is the insertion of the 
muscle. 

THE ORGANS. 

A BKIEF DESCRIPTION, BEGINNING WITH 
THE BEAIN. 

This organ is divided into the cerebrum, or the great 
brain, and the cerebellum, or little brain. The cerebrum 
occupies all that portion of the skull above the level of 
the ears, and the cerebellum is situated below the level, 
and occupies the lower and posterior portion. A thin 
membrane, stretched tightly, constitutes the partition 
between the two ; and its being thus tense is to prevent 
the cerebrum, from its superior weight, from pressing 
against the cerebellum, and thereby obstructing its 
function. The cerebrum is divided into right and left 
hemispheres, and these hemispheres again into six lobes, 
two anterior, two middle and two posterior. The cere- 
bellum is divided into right and left lobes. In the brain 
originate nine paies of neeves and the spinal marrow, 
from which arise thiett one paies of neeves, by whose 



110 THE FAMILY PHYSICIAN 

means the various senses, as seeing, hearing, tasting, 
smelling and perception are performed and muscular 
action given. These nerves, like so many telegraph 
wires, convey all impressions to the general office — the 
brain, where they are stamped upon that organ, which is 
the seat of intellect ; the nerves are the avenues to it — 
all intelligence must come by and through them. 

The brain is the seat of our intellectual nature, while 
the heart is the seat of our emotional nature. But the 
impression that creates the emotions must come first to 
the brain, through the ^.ve senses, by the nerves and 
make the impress on the brain, and then the heart or 
emotional nature is acted upon. I have neither time nor 
space to develop this interesting subject, but must pro- 
ceed to notice the 

LUNGS. 

These organs are situated in the cavity of the chest, and 
constitute the breathing apparatus. The right lung is 
divided into three lobes, and the left into two. The 
upper portion of the lungs is attached to the neck by 
means of the tracha or wind pipe, and to the heart by 
the pulmonary arteries. 

The air cells of the lungs, which resemble, to some 
extent, the comb of the honey bee, are supplied with air 
by means of the bronchial vessels, which extend through- 
out the various portions of the organ, terminating in the 
former. They are also surrounded by a membraneous 
covering termed the pleura. The lungs are the organs 
implicated in consumption, and are more or less influ- 
enced or diseased in pleurisy and pneumonia, particu- 
larly the latter. 

THE HEAET. 

The heart is an organ situated in the left cavity of the 
chest, resting on the diaphragm or midriff, to the left of the 



AND GUIDE TO HEALTH. Ill 

sternum or breast bone, between the fifth and sixth ribs. 
It is contained in a strong membraneous sac termed the 
pericardium, which secures it in its proper situation. It 
is divided into four cavities, termed the auricles and ven- 
tricles. It continually contracts and dilates, and at each 
pulsation throws the blood to every part of the body 
with amazing velocity. The number of its contractions 
in a single day is computed to be one hundred tlionsand. 
Plato, in speaking of the heart, remarks : " It is the 
centre or pivot of the blood vessels — the spring or foun- 
tain of the blood which is carried impetuously around." 
The blood is the pabulum or food of the flesh, and, for 
the purpose of nourishment, the body is laid out in 
canals, like those which are drawn through gardens, that 
the blood may be conveyed, as from a fountain, to every 
part of the body. The heart contracts and throws the 
blood into the lungs to be vitalized ; from the lungs it is 
carried back into the left side of the heart; the heart 
contracts and throws this renovated blood into the arte- 
ries, and by them it is carried all over the body to nourish 
it. After it has thus circulated all over the body it is 
returned by the veins to the right side of the heart, 
where it is poured into the heart, mixed with the chyle, 
again sent to the lungs and prepared to go the rounds. 
All the blood in the body, which amounts to three or 
four gallons, passes through the heart on its way to 
and from the lungs every four minutes. " The fool hath 
said in his heart, there is no God." Who but a fool or 
a lunatic, after examining the structure of the heart 
alone and the circulation of the blood through it, can 
doubt the existence of its maker, G-od. 

THE STOMACH. 

The stomach is a membranous, muscular sac, a greater 
portion of which is situated in the left side of the abdo- 



112 THE FAMILY PHYSICIAN 

men, mostly under the diaphragm and the ribs. It 
reaches toward the right side, a little beyond the "pit 
of the stomach," as it is termed. It resembles in shape 
the Scotch bag-pipe. The place where the food enters is 
called the cardiac orifice. This name was given it by 
the ancients becanse they thought it very near the heart. 
The outlet is called the pyloric, which closes and pre- 
vents the entrance of improper articles into the intestines. 
It is supplied with numerous glands, blood vessels and 
nerves. It has three coats : the external is the peritoneal, 
the second is the muscular, and the third and inner coat 
is mucous or villous, which contains numerous absorbing 
and exhaling vessels, which secrete the fluids in diges- 
tion. The sympathy of the stomach with other organs 
renders it one of the most important parts of the body ; 
it is the great centre of sympathy. The great sympa- 
tlietic nerve leads from the brain to the stomach, which 
effects so many contiguous portions of the system when 
it is disordered. Nutrition depends upon the stomach, 
as also does innervation, to some extent, for a full de- 
scription of which the reader is referred to a the article 
under that head. 

THE LIVEE. 

This organ is the heaviest glandular viscus in the 
body, upon the integrity of which depends, to a consider- 
able extent, the health of many of the organs. It is 
divided into right and left lobes. The right or largest 
lobe is situated immediately under and below the false 
ribs, and the left over a portion of the stomach, in the 
epigastric region. The use of the liver is to secrete bile, 
and it also exercises no inconsiderable influence over the 
digestive process. 



AND GUIDE TO HEALTH. 113 

THE GALL BLADDER 

Is an oblong, membranous sac, situated under and 
attached to the liver in the right hypocondrium. It is 
the receptacle of the bile carried to it and secreted by 
the liver, and discharges it by a small duct into the 
duodenum, just below the pyloric orifice, which, it will 
be recollected, is the outlet of the stomach. 

PANCREAS. 

This gland is vulgarly known when found in the hog 
as sweet bread ; it is situated immediately between the 
stomach and spine, at right angles with the latter. The 
pancreatic juice is secreted by the pancreas, and unites 
with the chyle in the duodenum. It assists in the pro- 
cess of digestion. 

SPLEEN. 

The spleen is a spongy, livid viscus, and so variable 
is it at different times and under different circumstances 
that it is a matter somewhat difficult to determine accur- 
ately either its shape or situation. It will, however, 
generally be found between the eleventh and twelfth 
ribs in the left hypocondrium. In shape it is oblong and 
round, or resembling an oval. It is said to be larger 
when the stomach is empty, and smaller when the 
stomach is full, by which it is compressed. There is 
much speculation even now about the use and functions 
of the spleen. I will not attempt to notice any of them ; 
it is most likely that it plays some part in digestion. 

KIDNEYS. 

The kidneys are situated each side of the spine, in the 

lumbar region or small of the back, being in shape 

something like a bean. 
8 



114 THE FAMILY PHYSICIAN 

The use of these organs are for the secretion of urine. 
Near the middle of the kidneys, at the extremities of the 
"blood vessels, is a funnel shaped sac, termed the pelvis, 
forming a passage to the bladder, which it perforates 
obliquely. This passage or canal from the kidneys to 
the bladder is termed ureter. 

BLADDER. 

The bladder is a membranous pouch, situated back of 
the ossa pubis in the pelvis, in the lower portion of the 
abdomen, possessing the power of expansion and con- 
traction. Its figure is that of an oval, being rounder 
above than below when empty, but when full is broader 
below than above. The urine is received in this organ 
by means of the ureter, and is expelled from thence by 
the voluntary action of the muscular fibres. 

INTESTINES. 

By the intestines is meant the whole of the alimentary 
canal below the stomach. They are divided into small 
and large. The small are subdivided into the duodenum, 
the jejunum, and the ileum, the large into the ccecum, 
the colon and the rectum. They are coiled up, or lie in 
folds in the abdomen, and extend about thirty feet in 
length. Those who depend upon emetics to cleanse this 
vast extent, or upon injections, must be doomed to disap- 
pointment. And when we take into consideration the 
tenderness of this delicate mucous membrane, we almost 
shudder at the thought of drastic cathartics being re- 
peated from day to day, as is the habit of some of our 
misguided " heroic " practitioners. In this lies the secret 
of so many diseases " running into dysentery ;" this 
delicate membrane is inflamed by the use of their 
medicines, hence nature finds herself (instead of being 



AND GUIDE TO HEALTH. 115 

assisted and sustained so as to resist and combat success- 
fully the disease that is preying npon her) encumbered 
with another disease often more formidable than the 
original. 

The coats of the intestines are similar to those of the 
stomach. The muscular coats contain longitudinal and 
circular fibres, which, by their contraction and relaxa- 
tion, produce vermicular or peristaltic motion, compared 
to the creeping of a worm. These serve to propel the 
contents of the intestines out of the body. The small 
intestines assist in the preparation of the chyle and pro- 
pel their contents toward the great intestines. The 
proper use of the intestines is to serve for the perform- 
ance of chylification, for the absorption of the nutritive 
chyle, and as a reservoir for the indigestible residue of the 
food and an outlet for both it and the effete matter which 
require to be thrown out of the general system. The 
bowels or intestines, as well as the stomach, exercise a 
great influence in the grand process of " nutrition." The 



Clear and delicate, arise from the mucous coat of the 
small intestines, passing in their course through small 
glands and terminating in the thoracic duct. Their 
ofiice is to absorb the milky fluid or chyle from the food 
and to convey it from the intestines to the blood. Lym- 
phatics take up fluids from the different cavities and 
parts of the body and convey them into the circulation. 
The lacteals, mesenteric glands and the thoracic duct are 
all engaged in this important and beautiful process. 
The lacteal vessels are most easily seen an hour or two 
after a meal, because they are then fully distended with 
chyle, even in their smaller branches. The latter, in- 
deed, may then be distinctly traced proceeding from the 



116 THE FAMILY PHYSICIAN 

different portions of intestines and gradually coalescing 
into larger trunks. 

THE SKIN. 

The skin is a smooth, delicate, external membrane 
which forms the beautiful covering of the whole body. 
It is the last stroke of the great artist which gives the 
finishing touch and makes the form divine. It is very 
superficial, and without it, or if removed, the most dis- 
gusting or revolting spectacle would be presented ; hence 
it is said that "beauty is but skin deep." First is the scarf 
skin, being the exterior part, insensible and rough. It 
is this which is raised in blisters, it is constantly wearing 
off, and is often renewed. Next to this is a very thin layer 
of paste, called rele mucosum, and on this depends the 
color. In the African this membrane or paste is jet black; 
in the Indian, copper colored; in the Spanish, yellow; 
and in our race, white, which is ridiculed in Africa as 
being pale and homely, they considering their color the 
standard of beauty. The third and last coat is the true 
skin, which is thicker than the others, and lies next to 
the muscles. It is freely supplied with blood vessels 
and nerves. The color of this membrane — the true skin 
— is nearly the same in all races of men, being as white 
in the African as the European or American. 

The skin performs a most important function in the 
animal economy. Two-thirds of the fluids taken into the 
stomach pass off by the skin. It has an infinite number 
of pores, which are designed to carry off extraneous and 
hurtful fluids from the blood ; and hence, when they are 
obstructed, so many diseases follow, by a knowledge 
of which we learn the true remedy, viz..: to restore its 
secretions, sustain the system and eliminate the poison. 
It is owing to this physiological view that we are led to 



AND GUIDE TO HEALTH. 117 

bathe thoroughly the whole surface, in fever and other 
diseases. I wish to impress this thing upon the mind of 
every reader, that the skin must be kept healthy and 
clean ; the pores must be kept open or the whole system 
will suffer. 

GLANDS 

Are organic substances, composed of blood vessels, 
nerves and absorbents, their use being to secrete or alter 
some peculiar fluid. They are generally divided by 
anatomists according to shape and structure or the 
fluid secreted. 

They are also divided into four classes, viz. : simple, 
compounds of simple, conglobate and conglomerate 
glands, which terms only apply to their fabric. Again 
they are divided into mucous, sebaceous, lymphatic, 
salival and lachrymal glands. The duct by which the 
fluio^is transmitted is termed the excretory duct. 

The vessels and nerves of a gland always come from 
the neighboring parts, and the arteries are possessed of 
a high degree of irritability. The use of the glands is 
to separate a certain fluid or to change it. 

MEMBRANE. 

A thin substance, expansive, which is composed of 
cellular texture, having the elastic fibres delicately inter- 
woven, which allows of a great degree of pliability. 
The membranes may be found in various parts of the 
body, as the pleura, dura-mater, diapJiragm, skin, &c. 
Independent of particular membranes are those named 
from a particular locality ; they are usually divided into 
serous, mucous and cellular. 

THE SEROUS MEMBRANE 

Lines the internal surface of the skull and serves to 
protect the brain ; it also is the covering of the stomach 
and intestines, and surrounds the lungs. 



118 THE FAMILY PHYSICIAN 

THE MUCOUS MEMBRANE 

Lines the internal surface of the stomach, lungs, intes- 
tines, bladder, eyelids, nose, mouth, &c, and is so termed 
from its secreting a whitish, slimy fluid, called mucous. 

THE CELLULAR MEMBRANE 

Is a cellular tissue, is composed of a great number of 
little cells, and is the connecting medium of every part 
of the body. It is found occupying the space between 
the muscles, thus filling up those portions which would 
otherwise be irregular and uneven. The cellular texture 
thus connects the muscular portions without interfering 
in the least with their natural functions. 

THE WOMB. 

The uterus or womb is an organ in the female about 
the size and shape of a pear, and is situated between the 
bladder and rectum, which secretes the catamenial fluid. 
It is suspended and kept in its place by means of liga- 
ments. In this organ the foetus or infant is formed. After 
the ovule in the ovary has been fecundated or vitalized by 
the spermatazoa of the male it is carried into the womb 
by the follopian tubes, where it is nourished by the blood 
derived from the mother through the umbillical cord or 
navel-string, till in nine months the womb contracts and 
expels it. 

ARTERIES. 

The arteries are strong, elastic, membranous tubes, 
which arise from the heart by two trunks, and convey 
the blood, by their innumerable branches, to every part 
of the body. They have three coats. 

VEINS. 

After the blood has been thus carried to every part of 
the system by the arteries the latter terminate in small 
vessels called capillaries, because they resemble hairs, 






AND GUIDE TO HEALTH. 119 

being so extremely small — they are smaller than hairs. 
These form the intermediate link between the arteries 
and the veins. The veins take their rise from these and 
return the blood to the heart. 

THE BLOOD. 

A red fluid, of saltish taste, which circulates in the 
heart, arteries and veins. It is the most important fluid 
in the body, and affords an interesting theme for the 
medical student. It is the source of heat, and by its 
flow in an undue proportion to any part the most dan- 
gerous conditions are produced, and often death. It fur- 
nishes materials from which all the parts of the body 
are supplied. Strength, health and life depend upon it, 
and the loss of a small quantity often damages the 
system. It stimulates the heart to contractions. It is 
thought by some to be the life principle. In the arteries 
it is of a crimson color ; in the veins, dark. It is changed 
in its passage through the lungs. 

THE NERVES. 

These are contractile bundles of white cords, the 
ends connected to the brain or spinal marrow, and thence 
extended over the whole body to receive impressions 
from external objects or to convey muscular motion. 
They are in pairs, issuing out of each side of the spine 
and thence to every part of the body, so that you can 
not touch any part of the skin with the point of a pin 
without coming in contact with a nerve and a blood vessel. 
The great sympathetic nerve is the most important of 
all. The main trunk of it communicates with all the 
spinal nerves and several of those of the brain. It pre- 
sides over all the organs which are affected independent 
of the will. 



120 THE FAMILY PHYSICIAN 



DEFINITION OF DISEASES, AND NAMES. 



" The attempt to define 'disease' must be a failure," 
says Reynolds, " until we are possessed of a satisfactory 
definition of 'health,' and we are not likely to arrive 
at this possession until we are able to define the idea 
that we entertain of the still more fundamental fact of 
'life.' Yet some attempt at a definition is not only im- 
portant, but even essential for the work set before us, 
inasmuch as the general ideas entertained about disease 
vary as the years pass on, and the position of 'medicine' 
in the 'system of the sciences' is not only expressed by 
the approximative definition that we frame of disease, 
but is actually determined by the principle or idea which 
such definition is constructed to convey. 

" If we regard disease in the abstract, we have to deal 
with that which changes, fetters, renders painful or puts 
an end to life ; and from this point of view disease may 
be defined to be any condition of the organisms which 
limits life in either its powers, enjoyments or duration. 
We need not stop to discuss the many futile essays that 
have been made to define that which transcends defini- 
tion, but which we all more or less accurately understand 
by life. "We accept it as a fact, of which we all know 
much, but of which we are all assured by what we do 
know that there is much more that we do not know ; for 
it goes beyond our observation, not only at its begin- 
ning and its end, but in its middle term, where it is the 



AND GUIDE TO HEALTH. 121 

most — but even then only partially — exposed to "both 
our senses and our consciousness. 

" If we consider disease from a less elevated point and 
deal with it as a fact of daily experience, we come to re- 
gard it as any departure from the structure or functions 
of the body as those are shown to us in health, and may 
define it to be an abnormal condition of function or 
structure, or both. But if we contemplate disease in 
relation to its many 'names' by which its various forms 
are recognized, we have a complicated problem with 
which to deal, and can only solve it by endeavoring to 
separate that which is common to all phases of ill-health 
from that which is peculiar to the various names by 
which those phases may be known, but by which they 
are only imperfectly expressed. And in order to do this 
we must call some typical examples of those names. A 
patient may be described as suffering from, or he may 
be said to be an example of, the disease called inflam- 
mation of the lungs, whooping-cough, tuberculosis, an- 
aemia, typhoid fever, hysteria, or of some other malady 
which would or would not readily fall into one or the 
other of these categories. And be it observed that by 
this term ' inflammation of the lung ' is expressed a par- 
ticular kind of change in one organ of the body; by 
'whooping-cough' is meant a special and characteristic 
variety of symptoms common to many very different 
affections ; by tuberculosis is intended some general 
change in the whole body distinguished from other gen- 
eral changes by its association with the appearance in 
one, two or many organs of a particular material known 
as tubercle ; by 'aneemia' is understood literally only an 
absence or deficiency of blood, but generally an altera- 
tion of quality rather than of quantity; by 'typhoid 
fever ' is conveyed the idea of a change of a particular 



122 THE FAMILY PHYSICIAN 

type in the whole organism, and one which is pro- 
duced "by the introduction into the body of a poison 
from without ; while by ' hysteria ' and similar phrases 
is conveyed some meaning or none at all, and when 
the former, a meaning as various in character as 
are the individuals who use the word. There are other 
principles upon which disease has been named and 
by which it is now described, but these examples are 
sufficient to show by their very existence the varying 
prevalence, at different periods, of diverse theories about 
disease ; about the one organ to the whole system of 
organs ; the nature of the changes which different organs 
may undergo ; the value of particular functional altera- 
tions and of special symptoms ; the relation of the blood 
to life and to the tissues of the body ; the lien between 
certain materials we can see and some general conditions 
we can appreciate by their effect on life ; the position in 
which life functions stand to the various poisonous agen- 
cies around them and within them, and the concealments 
by patent facts of little moment by important conditions 
which may be inferred to be their cause." 

Thus the history of a science might be shown to be 
written in the names by which the objects about which 
it is concerned have been described and recognized, but 
such is not the end now in view ; it is to show that the prin- 
ciples upon which disease has been named have varied 
widely, not oirfy at different periods, but at the same 
time; and that so great is the diversity among them, 
and so strangely aberrant are the forms which disease 
sometimes assumes, that hitherto no self-consistent 
and at the same time practical nosology has been 
derived ; and that, therefore, it is thought better in this 
work to retain old names that are understood, although 
based upon doubtful, if not erroneous pathology, rather 



AND GUIDE TO HEALTH. 123 

than, as a general tiling, to invent new terms which wonld 
not be well understood., and would, perhaps, partake of 
many of the fanlts of their predecessors. I have, there- 
fore, only invented a few names, snch as "exndation of 
the liquor sanguinis " for inflammation, and "rheumatced 
myositis " for muscular rheumatism, &c, all of which 
have been properly explained as they have occurred. 
Therefore we accept gradually a nosology of the most 
complex composition with the tacit or expressed admis- 
sion on all hands, that by " pneumonia " much is meant 
beyond the particular condition of the lung; that it 
implies changes antecedent to itself in the general nutri- 
tion of the body, and alterations in all the tissues and in 
their processes when the disease itself appears ; that the 
words " whooping-cough " convey more than is included 
in a particular variety of cough which is characterized 
by a whooping sound, viz. : the well known history and 
social relationship of a disease altogether distinct from 
the paroxysmal cough and whooping sounds not rarely 
met with in cases of chronic bronchitis and emphysema ; 
that by " tuberculosis " is intended a condition as well 
marked by general as by local changes, and, probably, 
dependent upon some constitutional vice which deter- 
mines, and is not determined by, the special form of 
local changes ; that by " ansemia " is meant much more 
than the etymology of the word can convey; that by 
" typhoid fever " is intended the description of a disease 
having relationship only very inadequately expressed 
by the words in common usage to denote it ; and that by 
' hysteria ' and similar expressions are understood more 
than the present state of medical science will explain, and 
much more than the words themselves accurately define. 
In this state of medical nomenclature and of medical 
science, as represented by the names it sanctions, it is 



124 THE FAMILY PHYSICIAN 

difficult to arrive at any other definition of disease than 
that it is the sum total of morbid changes in "both func- 
tion and structure ; and we must further admit that the 
names by which diseases are recognized are somewhat 
arbitrary terms, used for the purpose of recognition, 
without any constant value as to the meaning of those 
words in a system of pathology. Sometimes the name 
expresses what is believed to be the essential or most 
important fact ; sometimes the first link in a long chain 
of causes and effects ; sometimes a characteristic symp- 
tom or group of symptoms ; sometimes an idea as to how 
the disease originated ; and sometimes such a negation 
of all theory as contents itself with words which shall 
be understood to mean certain things to which they bear 
no more pathological relation, although they may have 
more seeming scientific value, than the common algebra- 
ical expressions for "unknown quantities," x, y, z. 

From this point of view, therefore, disease is defined 
to be the sum total of changes from a condition of health 
which may be recognized in either function or structure, 
or both, and the names of diseases are held to be merely 
convenient expressions for their recognition. 

STEUCTURAL AND FUNCTIONAL DISEASE. 

In describing the elements of what we call disease, 
two terms have been frequently used, " structure " and 
"function." These two phrases have passed into gen- 
eral use; the later, however, is somewhat objectionable, 
as its existence may be doubted. 

. SYMPTOMS OF DISEASE. 

" The meaning which now we must assign to the word 
'symptom' or 'sign' of disease is very different from that 
which some time ago would be conveyed by those terms," 
says Dr. Reynolds. So long as disease was regarded as 



AND GUIDE TO HEALTH. 125 

something put into, added to or engrafted upon the body, 
a material or other entity having even a more or less 
substantive existence, these words described the means 
by which we might recognize the presence of such an 
entity ; bnt so soon as disease is recognised to be what 
we have defined it, the snm of changes in function and 
structure presented by the living being, the " symptom" 
and " sign " have another meaning, and describe only 
those parts of the disease which are appreciable by 
others. Disease is a complex state of complicated organ- 
ism, and although the name which we may give it may 
be intended to express its primary or most important 
fact, we can not separate this one fact from others with 
which it is associated, but must regard them as integral 
parts we have either to study or to treat. They may 
differ, from an outside point of view, in proximity of rela- 
tionship, but the heat of skin, the altered pulse, respira- 
tion ratio, the nature of the expectoration, the change in 
the secretions, in the nervous system and in the pros- 
pects of life, together with the altered resonance, breath 
and voice-sounds are as much parts of the disease called 
"pneumonia" as is the structural condition of the 
lung. Some of them may be signs by which we recog- 
nize its presence, but they are also essential elements of 
the malady itself. In like manner it might be shown 
with regard to those other diseases, the nomenclature of 
which differ as those we have already described, that a 
precisely similar relation exists between what we have 
denominated " symptoms" and what we understand by 
" disease." We can not know of the existence, during 
life, of any disease except by its symptoms ; we can not 
conceive of disease apart from some recognizable changes 
in either function or structure, and these changes consti- 
tute the disease ; nor can we, on the other hand, imagine 



126 THE FAMILY PHYSICIAN 

the existence of what we call " symptoms " apart from 
the correlative idea of what we conceive to "be " disease." 
The two classes of notion have been, of necessity, distinct 
in their development, Tbut the maintenance of distinction 
between them has been a hindrance to true progress in 
pathology, and it will be well for us to try and remove 
that hindrance. So long as " disease " is thought of as 
a something — it matters not what — distinct from the 
phenomena or " symptoms " by which it makes itself 
known, so long are we in danger of mistaking its real 
meaning and overlooking those true guides toward the 
removal or alleviation of its evil, an end to which all 
medical science ultimately points. 



AND GUIDE TO HEALTH. 127 



PRINCIPLES OF MEDICINE. 

ALL DISEASES DIVIDED INTO TWO GREAT CLASSES 
NUTRITION AND INNERVATION. 



Every animated being lias a limited period of existence, 
during which it is constantly undergoing a change. So 
long, however, as this change takes place uniformly in 
the different parts of which it is composed its physio- 
logical or healthy condition is preserved. But immedi- 
ately the action of one organ becomes excessive or weak 
in proportion to the others, disease or a pathological 
state is occasioned. This state may be induced by direct 
mechanical violence, but may also occur from the con- 
tinued or irregular influence of several physical agents 
upon the body, such as temperature, moisture or dryness, 
certain qualities of the atmosphere, kinds of food, etc. 
These are always acting upon the vital powers of the 
individual as a whole, as well as incessantly stimulating 
the various organs to perform their functions. Life, 
then, may be defined, in the words of Beclard, as " organ- 
ization in action." Health is the regular or normal, and 
disease the disturbed or abnormal condition of that 
action. 

While such may be assumed to be our notion of disease 
in the abstract, what constitutes disease in particular has 
been much disputed. From the time of Hippocrates to 
that of Cullen and his followers the external manifesta- 
tion or symptoms constituted the only means of recog- 



128 THE FAMILY PHYSICIAN 

nizing diseased action, and gradually came to be regarded 
as the disease itself. 

Then these symptoms were arranged into groups, 
divided, subdivided and named according to the predomi- 
nance of one or more of them, or the mode in which they 
presented themselves. These artificial arrangements are 
the nosologies of former writers. All philosophical physi- 
cians, however, have recognized that the true end of medi- 
cal inquiry is, if possible, to determine rather the altered 
condition of the organs which produce the disordered 
function than to be contented with the study of the 
effects it occasions. But the difficulty of this inquiry 
has been so great, and a knowledge of the means of 
prosecuting it so limited, that it is only within the last 
quarter of a century that medicine has been able to build 
up for herself anything like a solid scientific foundation. 
What has hitherto been accomplished in this way has 
been brought about by the conjoined cultivation of mor- 
bid anatomy, pathology and clinical observation, greatly 
assisted, however, by the advance of numerous collateral 
branches of science, and especially in recent times by 
chemical and histological investigation. The result has 
been a complete overthrow of nosological systems. We 
now attempt to trace all maladies to their organic cause ; 
and just in proportion as this has been successfully 
accomplished has medicine become less empirical and 
more exact. The organic changes, however, which pro- 
duce or accompany many diseases have not yet been 
discovered, and, consequently, a classification of all 
maladies on this basis can not be strictly carried out. 
The organic cause of epilepsy, hydrophobia, and of 
many fevers, for example, is as yet unknown. In the 
present state of medicine, therefore, when the morbid 
change in an organ is unequivocally the origin of the 



AND GUIDE TO HEALTH. 129 

symptoms, we employ the name of the lesion to desig- 
nate the disease ; but when there is disturbance of 
function without any obvious lesion of a part we still 
make use of the principal derangement to characterize 
the malady. Thus, as regards the stomach, we say a 
cancer or an ulcer of that viscus, and thereby express 
all the phenomena occasioned. But if we are unable to 
detect such cancer or ulcer, we denominate the affection 
after its leading symptom, dyspepsia, or difficulty of 
digestion. In endeavoring to carry out this distinction, 
however, modern physicians have fallen into a great 
error, inasmuch as they have continued to employ the 
nomenclature of our forefathers, and use words simply 
expressive of the presence of symptoms to indicate the 
altered condition of organs which are the cause of those 
symptoms. Formerly the term inflammation meant the 
existence of pain, heat, redness and swelling; it now 
represents to us certain changes in the nervous, vascular, 
and the texture of glandular and other organs and 
tissues, by congestion and the exudation of the liquor 
sanguinis. Formerly apoplexy meant sudden uncon- 
sciousness originating in the brain, now it is frequently 
used to express hemorrhage into an organ, and the terms 
apoplexy of the lung and of the spinal cord. The two 
ideas are essentially distinct, and bear no reference 
to each other, because the same word may be, and 
often is, employed under circumstances where its 
original meaning is altogether inapplicable. Hence 
it is incumbent on every one who applies to organic 
changes terms which have been long employed in 
medicine to define exactly what he means by them. 
In this way old, indefinite expressions, though still re- 
tained, will have a more precise meaning attached to 

them. If, for instance, it be asserted that bleeding cuts 
9 



130 THE FAMILY PHYSICIAN 

short an inflammation, let it be explained what is cut 
short — whether the symptoms, the physical signs, a con- 
gestion of the vessels, or an exudation of the liquor 
sanguinis. 

But, notwithstanding the confusion in our nosological 
systems and the frequent change of ideas with regard to 
the nature of morbid actions which have necessarily re- 
sulted from the rapid advance of medicine in late years, 
it still follows that disease is only an alteration in the 
healthy function of organs. Hence all scientific classifica- 
tion of maladies must "be founded on physiology, which 
teaches us the laws that regulate those functions ; there- 
fore I venture to divide all diseases into two great classes 
— diseases of nutrition and diseases of innervation. 



AND GUIDE TO HEALTH. 131 



GENERAL LA.W OF NUTRITION 

AXD OF INKEKYATIOX m HEALTH AND DISEASE. 






The origin of disease has been ascribed by some to 
an altered condition of nutrition and of the blood, whilst 
others have regarded even this function as subservient to 
that of innervation. In man we find them united, and it 
is difficult at all times to tell what are purely nutritive 
and what are purely nervous phenomena. But a consid- 
eration of animated nature at large must satisfy us 
that in the vegetable world, as well as in some forms of 
animal life, nutrition may proceed independently of a 
nervous system. We also feel satisfied, in theory as 
well as in fact, the function of nutrition is capable of 
being separated from that of innervation. Doubtless, 
there is no lesion whatever which does not in the higher 
class of animals involve both nutritive and nervous 
changes ; but the only method of arriving at a knowledge 
of their conjoint action, or the mutual influence, or the 
manner in which sometimes one predominates over or 
mingles with the other, is by studying in the first in- 
stance the laws by which each seem to be governed.. 

FUNCTION OF NUTEITION. 

" The various modes in which nutrition becomes im- 
paired and the blood diseased can only be understood 
by passing in review the different steps of the nutritive 
process. For ages medical men have been in the habit 



132 THE FAMILY PHYSICIAN 

of considering the blood to Tbe the primary source of 
different maladies. It will "be onr endeavor to show, by 
an analysis of the process of nutrition, that the changes 
of the blood, and the diseases which accompany them, 
are, for the most part, not primary, but secondary — that 
is to say, they are dependent on previously existing cir- 
cumstances, to the removal of which the medical practi- 
tioner must look for the means of curing his patient." 
He must second nature in her efforts to remove. 

The process of nutrition in man consists of the intro- 
duction into the stomach and intestinal canal of appro- 
priate alimentary matter or food, then the formation 
from these of a nutritive fluid, the blood, and the changes 
it undergoes in the lungs, the passage of fluid from the 
blood to be transformed into the tissues, the disappear- 
ance of the transformed tissues and their re-absorption 
into the blood, and the excretion of these effete matters 
from the body in various forms and by different channels. 

These different stages comprehend not only growth, 
but the process of assimilation, absorption, secretion 
and excretion ; and we believe it is only by understand- 
ing the function in this enlarged sense that we can obtain 
a correct explanation of those important affections which 
may appropriately be called diseases of nutrition. 

The nutritive functions are all connected with one 
another, and excess or diminution of local growth, by 
subtracting from or adding to the constituents of the 
blood, must produce an alteration in that fluid both as 
to quantity and quality. 

The process of nutrition is a continuous round, which 
in the natural world may be said to commence with the 
reception and terminate with the preparation of aliment, 
vegetable or animal ; that this is observable not only in 
the chemical balance of organic nature, but in the inces- 



AND CIUIDE TO HEALTH. 133 

sant chemical compositions and decompositions, as well 
as structural formations and disintegrations, which are 
peculiar to all vital entities. 

We can now more readily understand how a derange- 
ment in any one stage of the nutritive process affects the 
others. Thus, if alimentary matter is not furnished in 
sufficient quantity and of a proper quality the blood is 
rendered abnormal, and it necessarily follows that the 
matters it gives off will be abnormal also, and its subse- 
quent transformation is more or less modified. Again, 
if secretion be checked, the blood is not drained of its 
effete matter; and if excretion be prevented, the secre- 
tions themselves may enter the blood and act upon it as 
a poison. 

A diseased or morbid state of the blood, therefore, 
may arise from either of the stages of nutrition which 
we have mentioned, being rendered irregular or other- 
wise abnormal. 

In whatever part of the circle interruption takes place 
it will, if long continued, affect the whole. Thus, a bad 
assimilation of food produces through the blood bad 
secretions and excretions, whilst an accidental arrest of 
one of the latter reacts through the blood on the assimil- 
ating powers. The forms of disease thus arising may be 
endless, but as regards nutrition they may all be traced 
to the following causes : 

First, An improper quantity or quality of the food. 

Second, Circumstances preventing assimilation or im- 
peding respiration. 

Third, Altered quantity or quality of nutritive matters 
passing out of the blood. 

Fourth, The accumulation of effete matters in the 
blood. 



134 THE FAMILY PHYSICIAN 

Fifth, Obstacles to the excretion of those from the 
"body. 

The principles I desire to call particular attention to 
and establish are, that diseases of nutrition and of the 
blood are only to be combated by an endeavor to restore 
the deranged process to their healthy state in the order 
in which they were impaired ; that a knowledge of the 
process of nutrition is a preliminary step to the proper 
treatment of their affections ; that the theory of acting 
directly on the blood is incorrect ; and that an expectant 
system is as bad as a purely empirical one. 

FUNCTION OF INNERVATION. 

The function of innervation is also made up of the 
performance of various actions, widely different from 
each other, although associated together. These actions 
lead to the manifestations of intelligence, sensation and 
combined motion. But as the connection between these 
is not capable of exhibiting such an order of sequence as 
has been made apparent among the nutritive processes, 
we will not go into a lengthy description of it in this 
place ; still all the functions of the nervous system may 
be increased, perverted or destroyed, according to the 
degree of stimulus or disease operating on its various 
parts. Thus, as a general rule, it may be said, that a 
slight stimulus produces increased or perverted action ; 
whilst the same stimulus long continued or much aug- 
mented causes loss of function. 

All the various stimuli, whether mechanical, chemical, 
electrical or physical (mental), produce the same effects 
and in different degrees. Circumstances influencing the 
heart's action, stimulating drinks or food act in a like 
manner. Thus, if we take the effects of alcoholic drink 
for the purpose of illustration, we observe that, as regards 



AND GUIDE TO HEALTH. 135 

combined movements, a slight amonnt canses increased 
vigor and activity in the muscular system. As the sti- 
mulus augments in intensity we see irregular movements 
occasioned, staggering and loss of control over the limbs. 
Lastly, when the stimulus is excessive there is a com- 
plete inability to move, and the power of doing so is 
temporarily annihilated. With regard to sensibility and 
sensation, we observe cephalalgia, tingling and heat of 
skin, tinnitus aurium, confusion of vision, muscse volitant, 
double sight, and lastly complete insensibility and coma. 
As regards intelligence, we observe at first a rapid flow 
of ideas, then confusion of mind, delirium, and lastly 
sopor and perfect unconsciousness. (Glorious drunk). 
In the same manner, pressure, mechanical irritation and 
the various organic diseases produce augmented, per- 
verted or diminished function, according to the intensity 
of the stimuli supplied or amount of structure destroyed. 
Excess or diminution of stimuli, too much or too little 
blood, very violent or very weak cardiac contractions, 
and plethora or extreme exhaustion, will, so far as the 
nervous functions are concerned, produce similar alter- 
ations of motion, sensation and intelligence. Excessive 
hemorrhage causes muscular weakness, convulsions and 
loss of motor power, perversions of all the sensations, 
and lastly unconsciousness from syncope. Hence the 
general strength of the frame can not be judged of by 
nervous symptoms, although the treatment of them will 
be altogether different, according as the individual is 
robust or weak, has a full or small pulse, &c. The 
similar effects on the nervous centres, from apparently 
such opposite exciting causes, can, it seems to me, only 
be explained by the peculiarity of the circulation. A 
change of circulation within the cranium takes place, 
and, whether arterial or venous congestion occurs, pres- 



136 THE FAMILY PHYSICIAN 

sure on some portion of the organ is equally the result. 
The importance of paying attention to this point in the 
treatment must be obvious. 

THE SEAT OE DISEASE IN THE NERVOUS SYSTEM — 
INFLUENCE — THE NATUEE AND SYMPTOMS. 

It is a matter of very great importance to ascertain 
how far certitude in diagnosis may be arrived at and 
the seat of disease ascertained. As a general rule it may 
be said that diseases of the brain proper are more 
especially connected with perversion and alteration of 
the intelligence ; whilst disease of the cranial portion of 
the spinal cord and base of the cranium are more par- 
ticularly evinced by alterations of sensation and motion. 
In the vertebral portion of the cord the intensity of pain 
and of spasm, or else the want of conducting power 
necessary to sensation and voluntary motion, indicates 
the amount to which the motor and sensitive fibres are 
affected. Further than this we can scarcely generalize 
with prudence. The fatality of lesion affecting various 
parts of the nervous centres varies greatly. The hemis- 
pheres may be extensively diseased, often without injury 
to life, or even permanent alteration of function. Con- 
vulsions and paralysis are the common results of disease 
of the ganglia in the cranial or upper portion of the 
cord. The same results from lesion of the varolii. But 
if the medulla oblongata, where the eighth pair of nerves 
originates, be affected, or injury to this centre itself 
occur, it is almost always immediately fatal. 

This is a "bird's eye" view of the nutritive and nerv- 
ous functions, viewed separately, but it must be borne 
in mind that the physician has continually to do with 
their conjoint action. Indeed, the derangement of one 
order of functions exercises a constant influence over the 



AND GUIDE TO HEALTH. 137 

other, so that in every disease the effects of disordered 
nutrition are visible in perverted innervation, and the 
converse. Thns an improper quantity or quality of 
food produces sometimes excitement, at others dullness 
of intellect. Various articles of diet have been known 
to cause violent headache and different kinds of nervous 
phenomena ; while starvation, if long continued, excites 
delirium, paroxysms of mania, and lastly, stupor. In 
children, derangement of the alimentary canal is the 
most common cause of spasm and convulsion, and in the 
age4 it often leads to apoplexy and palsy. Again, im- 
peded respiration, poverty of the blood, accumulation of 
effete matters in the system, suppressed secretions and 
obstructed excretions, are all accompanied or followed 
by disorders of innervation. On the other hand, the 
influence of the nervous system on nutrition is equally 
apparent. Syncope, and even death itself, have been 
occasioned by mental emotions. Anxiety and sup- 
pressed grief predispose to diseases of the stomach, 
and thereby to altered nutrition, terminating in various 
maladies. The reception of joyful or distressing intelli- 
gence, it is well known, invigorates or depresses the 
bodily energies. Various organs are excited to action 
by particular trains of thought or desires, and the coun- 
tenance is reddened by modesty and blanched by fear. 
As a general rule, it may be said, while slight emotions 
increase the secretions, very violent ones, particularly if 
suppressed, completely suspend them, and are most 
dangerous to life. Direct mechanical injury to the large 
nervous trunk, in addition to causing paralysis, is now 
recognized, in some cases, to produce increased heat and 
redness in parts, often followed by exudation and ulcera- 
tion. In chronic cases such paralysis leads to atrophy 
and withering of a limb or some other portion of the 



138 THE FAMILY PHYSICIAN 

body. Very rarely injury of a great sympathetic trunk 
produces similar loss of nutrition without impairment of 
sensibility or emotion. 

This is all I shall attempt to say now in regard to 
nutrition and innervation. In the symptoms and treat- 
ment of special diseases the principles now detailed will 
be constantly illustrated. The subject is one of vital 
importance, and need I add, of particular interest, as it 
lies at the foundation and origin of the disease ; in either 
one or the other, or both, disease must have its origin. 
Hence to the medical student there is no subject that can 
present itself that is of more vital importance or interest, 
and I need not add, more instructive. 



AND GUIDE TO HEALTH. 139 



INFLAMMATION. 

(EXUDATION.) 



"When a part becomes hot, red and painful it is said 
to be inflamed. It may be general or local. Inflammo, 
to burn. The disease is so called in consequence of the 
burning pain felt in a part affected with it. The name 
"inflammation" simply describes a- symptom, and but 
one symptom — the heat. As a name for that symptom I 
do not object to it. But as a name for a pathological 
condition it seems to me to be vague, inaccurate and 
meaningless. The great fact that there is something in 
a name is continually being realized by the medical stu- 
dent. The old aphorism, that " a rose by another name 
would smell as sweet" is doubtless true, but is no argu- 
ment to prove that it would be as readily recognized if 
called by another name. We want to use names that 
will convey an idea — names that will express or describe 
a thing or a condition. There is nothing that has added 
more to the confusion that exists to-day in the religious 
world than the reckless use of names — names that do 
not describe or express the condition of a true follower of 
Christ. Dying men and women look around them for a 
name that will connect them with a Savior, and in the 
1000 names that are distributed throughout the universe 
they can scarcely find one. Names that do not describe 
a disease or are connected with a pathological condition 
only serve to create confusion. Infla/mmo, as above 



140 THE FAMILY PHYSICIAN 

remarked, does not direct the mind to the pathological 
condition, but to one only of the symptoms ; hence I 
object to it, Bnt what is the disease, and what shonld it 
Ibe called ? In order to answer the question it will become 
necessary to examine the pathological condition. T7e 
find, first, the capillary vessels are narrowed and the 
blood flows through with greater rapidity ; second, the 
same vessels become enlarged and the current of blood is 
slower, although even ; third, the flow of blood becomes 
irregular ; fourth, all motion of the blood ceases and the 
vessels appear fully distended ; fifth and lastly, the 
liquor sanguinis (one of the constituents of the blood — not 
the red part) is exuded through the walls of the vessel, 
and sometimes there is extravasation of the red part 
(corpuscles) of the blood, owing to rupture of the capil- 
laries. Thus we have in order the process. Inflamma- 
tion was an expression created in the infancy of science 
altogether metaphorical, designed to represent a morbid 
state in which the parts appeared to burn. From the 
time of Hippocrates to that of Cullen and his followers 
the external manifestation or symptoms constituted the 
only means of recognizing diseased action, and gradu- 
ally came to be regarded as the disease itself. Then 
these symptoms were arranged into groups, divided, sub- 
divided and named according to the predominance of one 
or more of them. These artificial arrangements are the 
nosologies of former writers. In this way the prominent 
symptom (heat) was regarded as the disease and a name 
given it to express or describe the condition. 

All philosophical physicians, however, have recognized 
that the true end of medical inquiry is, if possible, to 
determine rather the altered condition of the organs 
which produce the disordered function than to be con- 
tented with the study of the effect it occasions. 



AND GUIDE TO HEALTH. 141 

The term inflammation is so very vagne and its inter- 
pretation so very arbitrary that it has really lost its 
value. It is like an old coin withont an impression, 
which ought to "be removed from circulation. Bnt the 
question is still pertinent and presses for an answer. 
What should it be called? Exudation of the liquor 
sanguinis is a demonstrative fact and gives rise to a defi- 
nite idea. Hence, for all scientific and practical purposes, 
the expression, exudation, may be snbstitnted for that 
of inflammation. Since we have fonnd a satisfactory 
term, onr further investigation of the snbject will be of 

SIMPLE EXUDATION. 

A clever writer says on that snbject, " Simple exuda- 
tion presents fonr principal forms. First, as it occurs on 
serous membranes, where it exhibits a finely fibrous 
structure, and has a strong tendency to be developed 
into molecular fibres ; second, as it occurs on mucous 
membranes, or in areolar tissues, where it is generally 
converted into pus corpuscles ; third, when it occurs in 
dense parenchymatous organs, such as the brain, where 
it assumes a granular form, and is associated with nu- 
merous compound granular corpuscles ; fourth, as it is 
poured out after wounds or injuries, and occurs on gran- 
ulating sores." 

In this last case the superficial portion is transformed 
into pus corpuscles, while the deeper seated is converted, 
by means of nuclei and cells, into nucleus and cell fibres, 
which ultimately form the cicatrix. 

It may be stated that congestion does not always pro- 
duce exudation, or, in other words, the blood may be 
withdrawn before the vessels are exhausted, and then 
the damage done them simply by being put upon the 
stretch for a short time is scarcely felt ; it is only when 



142 THE FAMILY PHYSICIAN 

the blood remains for some time in too great quantities 
in a part that the disagreeable symptoms are exhibited, 
the pain, redness and heat, or the exudation takes place. 
Thus, we may have congestion of the lungs, and not the 
pain and heat to any extent, or the exudation. The in- 
flammation or exudation does not develop. But if the 
afflux of blood remains for any considerable time we do 
have them, and a very formidable disease — pneumonia. 
It is so with other organs, and, in fact, every part of the 
economy. Any part may receive a sudden accumulation 
of blood, and it may be withdrawn without producing 
the symptoms and before there is any exudation. No 
part, however, is subject to any exudation without being 
preceded by congestion. 

The subject of inflammation is one of vast importance, 
and one that has elicited the attention of the medical 
fraternity from the days of the early fathers down to the 
present time. Theory after theory have rose and fell, 
and to-day the medical world stands divided on the im- 
portant subject. I say important, and well I may, in 
view of the solemn fact that at least one half of the 
premature destruction of human life is attributable to it. 
It would not be profitable for me to go into any detailed 
account of these different and antagonistic theories. 
Facts are what we are in pursuit of — leading, practical 
facts — that will aid us at the bedside of the afflicted. 
Hence I will only mention briefly some of these erroneous 
theories. Some urge that it is an affection of the capil- 
laries, others that it is an altered state of the nerves, 
while others claim it to be a change in the blood, and 
others still that it is a form of abnormal or irregular 
nutrition. 

Causes — The causes that produce inflammation or ex- 
udation are numerous, among which may be enumerated 



AND GUIDE TO HEALTH. 143 

cold, heat, bruises, wounds, poison, contagion, and in 
fact any tiling that is calculated to produce an irritation. 
Any irritant applied to the capillary vessels causes them 
to contract and narrow. The blood is forced more ra- 
pidly through them, according to a principle of hydrau- 
lics. As they enlarge the blood flows slower, on the same 
principle ; until it stops, exudation takes place — the dis- 
ease is established. 

SYMPTOMS. 

The constitutional symptoms are fever and buffyness 
of the blood. Thus, if blood be drawn from a vein, it 
will exhibit, after standing and coagulating, " the buffy 
coat." From this appearance of the blood has arisen 
the mistaken idea that inflammation was a changed con- 
dition of the blood — mistaking effect for cause. Thus 
we can see at a glance the importance of reasoning from 
cause to effect, and effect to cause. 

It is just so with the other symptoms that we have 
given — pain, redness and heat. They, instead of being 
inflammation, as some have averred, are simply effects 
of a cause or symptoms. Inflammation occasionally 
arises unexpectedly and from causes unknown. (I shall 
use the terms inflammation and exudation as synony- 
mous). In other instances it will be found to have been 
produced by some mechanical or chemical irritant, or by 
cold, or some morbid poison in the system, or contagion. 

It is said to be acute when it runs its course rapidly, 
and is attended with severe constitutional or local dis- 
turbance ; chronic, when its phenomena are less strongly 
marked. 

Subacute inflammation is marked by symptoms which 
are intermediate between acute and chronic, and which 
do not attain any great severity. 



144 THE FAMILY PHYSICIAN 

Terminations. — The terminations of inflammation are 
resolution or cure. This takes place when the blood is 
not allowed to remain in the part long enough to enfeeble 
the vessels or entirely exhaust them, so that they can not 
assume their normal condition as soon as the blood is 
withdrawn from the part ; when the blood has remained 
until they are entirely exhausted there is an effusion of 
lymph exudation, and it must terminate in suppuration 
or gangrene. 

" When the inflammatory action reaches a certain de- 
gree, the nervous and vascular systems become generally 
affected ; the general derangement which ensues being 
spoken of as inflammatory or symptomatic fever, or as 
constitutional disturbance. This fever manifests itself 
by depression, chilliness followed by heat, frequency of 
pulse, headache and furred tongue, thirst and loss of 
appetite. Sometimes the chilliness amounts to shivering, 
and it is generally allowed that the onset of spontaneous 
inflammation is more frequently attended with rigors 
than that of inflammation to external injury." 

If the inflammation goes on to suppuration, the com- 
mencement of this event is commonly marked by the 
occurrence of shivering, and the constitutional disturb- 
ance is then called hectic fever, the leading symptoms of 
which are frequency and weakness of pulse and alterna- 
tions of chilliness with heat and flushing, followed by 
sweating, a gradual wasting of the body and daily 
increasing debility. The terminations of internal in- 
flammation are sometimes suppuration and sometimes 
adhesion. 

Treatment. — I can only give the general principles of 
the treatment of inflammation here. In the commence- 
ment the grand object will be to relieve, if possible, the 
congestion. If this can be done early the symptoms, 



AND GUIDE TO HEALTH. 145 

pain, redness and heat, quickly disappear. This is called 
resolution or cure ; but if those symptoms are fully 
developed and the exudation established, it is not pos- 
sible to cut it short. Then our duty will be to guide the 
morbid process to a favorable termination, just in the 
same way as we do at present try to conduct cases of 
typhus, smallpox, scarlatina, &c, through their natural 
process without making heroic and injurious efforts to 
cut short the disease. The important point, then, for 
consideration is, how to accomplish these objects. I will, , 
without stopping here to review the antiphlogistic 
regimen which has been relied upon so long, and which 
consists of low diet, blood letting, active purging, counter- 
irritation, mercury and antimony, after offering a single 
objection to them, proceed to give what I conceive in my 
mind, and what experience has taught me at the bedside, 
to be the true course of treatment. 

My objection to bleeding is, that general bleeding, un- 
less carried to a very dangerous extent, will not diminish 
the amount of blood in an inflamed part ; that bleeding 
will not render an impure blood pure ; that depressing 
agents favor the extension of the morbid action and 
deprive the system of the power of rallying from the 
effects of the disease ; that in many instances of inflam- 
mation there is depressed nervous power, an impaired 
action of the heart, and that in all cases a lowering plan 
of treatment is found to be a positive injury to the patient 
and to fearfully increase the list of mortality. Hence 
we discard the whole plan as one of the great errors in 
the practice of medicine, and treat inflammation on a 
plan the very opposite of it, i. e., by supporting the vital 
powers instead of lowering them. 

If there is much febrile excitement, quick pulse and 

heat, it will be well to give a saline cathartic, followed 
10 



146 THE FAMILY PHYSICIAN 

after its operation "by full doses of Dover's powders. This 
is a valuable remedy ; it not only eases pain, but is of 
incalculable value in its action on the skin. Every means 
must be used to assist the excretion of effete products. 
The bowels must be kept regular and soluble, the skin 
clean and free from all obstructions and the kidneys 
faithfully performing their work of secreting ; this last 
may be done by the use of the sweet spirits of nitre in 
teaspoonful doses three or four times a day. The first 
indication, that of keeping the bowels soluble during the 
febrile excitement, can best be done by the use of citra- 
tized magnesia, or Seidlitz powders, or common Epsom 
salts ; this, however, must not be continued longer than 
the febrile excitement is present. After this the bowels 
must only be kept regular, which may be done, if any 
agent is required at all, by the use of injections. The 
skin may be kept in good condition by the use of the 
Dover's powders and baths, either tepid, hot or cold, as 
seems the most comfortable and judicious in the mind of 
the practitioner. But during the whole time the diet of 
the patient must be light but nutritious, with plenty of 
cold drinks. All sources of irritation must be removed 
from the patient ; the room must be well ventilated and 
kept at a temperature of about 60 ° Fahr. "When the 
pulse becomes soft, good beef tea and nutriments are to 
be administered; and directly there are indications of 
weakness we may administer wine in quantities varying 
from four ounces to twenty in twenty -four hours. Good 
Scotch ale or porter may be used in the place of wine. 

I have said that the diet should be light and nutritious, 
but " to give food when there is a perfect loathing of it 
is worse than useless ; but," says Dr. Tanner, " we may 
advantageously give alcohol and wine to retard the 
destructive metamorphosis of tissue, to afford to the sys- 



AND GUIDE TO HEALTH. 147 

tern the elements for the generation of heat, to repair the 
nervous energies and to supply a stimulus to the nervous 
system." As the period or crisis approaches, Dr. Ben- 
nett's example may be followed, of giving a diuretic — 
spirits of nitric ether half a drachm, with or without ten 
drops of colchicum wine thrice daily, to favor the excre- 
tion of urates, while where a crisis occurs "by sweating 
or diarrhea, care is to be taken not to check it in any 
way." 

It may not be out of place to remark here with regard 
to mercury in the treatment of inflammation, that its 
virtues have been vastly overrated, and, in fact, that it 
seems highly probable that inflammatory disease will 
progress more favorably without the use of it than with 
it. Tartar emetic in small doses given with Dover's pow- 
ders is of great advantage to the skin, and will prove a 
valuable auxiliary in the treatment of the disease. 

I have an abiding faith in nature and its marvelous 
powers to protect itself against disease, to ward off some 
and to cure others, and by a process of its own bring 
others in the most speedy way to a favorable termina- 
tion. Then, what is truly the office of a physician ? Is it 
not clearly to assist nature to perform her work ? Can 
we do this best by lowering the system, breaking down 
her powers, and rendering her less able to combat and 
withstand the attacks of the enemy ? Certainly not ; but 
it is clearly his duty to study in the great school of 
nature, understand her workings and her objects, and 
then furnish her the very best means at his command to 
assist her in her great work of curing disease. This 
innate power is called vis nature? medicatrix. Of itself 
it is sufficient to cure a great many diseases, and, in fact, 
often overcomes the effects and influences of improper 
remedies and cures the disease. It is a powerful prin- 



148 THE FAMILY PHYSICIAN 

ciple, without which I fear "but few "bad cases, indeed, 
would ever "be "brought to a favorable termination. The 
physician's duty is to study this great principle, and in 
all cases where it is unable to perform its work, to be 
able to assist it — be its ally in the movement against 
the common enemy, disease. The physician who does 
not study and properly appreciate this general principle 
can never be a successful one. Local means will be 
spoken of when we come to treat of local and special 
inflammations. To prevent or diminish the extent of an 
exudation we must adopt measures to overcome the 
dilatation of the capillaries, their distention with blood, 
and the attractive power which draws the liquor sanguinis 
into the surrounding textures. This is accomplished 
by local aprjlications of cold and astringents, which 
stimulate the capillaries to contractions, and by sooth- 
ing topical applications, such as warm fomentations, 
opiates, etc., which relieve the irritation of the nerves in 
the part. Blood letting, local or general, has long been 
supposed capable of meeting this indication, but, theo- 
retically, it can no longer be defended. 

When the exudation has coagulated it constitutes a 
foreign body, which either becomes organized or is re- 
moved by its dying. In the one case it acts as a blas- 
tema, in which cells are developed that ultimately break 
down, and so render it capable of being absorbed, which 
is called resolution, or they are converted into tissue that 
becomes permanent. In the other case it disintegrates 
slowly, constituting ulceration, or putrifies, forming moist 
gangrene, when it is separated from the economy in dis- 
charge as a slough. It is by regulating the formative 
power of the exudation that we check or favor resolu- 
tion, and we can only do this by employing those means 
which lessen or advance cell growth in all living organ- 



AND GUIDE TO HEALTH. 149 

isms. Tims, locally, cold, dryness and pressure check, 
while heat, moisture and room for expansion favor 
growth. And as regards the general system, the increase 
or diminution of food, nutriments and stimuli, act for or 
against this object. Hence you can readily see the im- 
portance of nutriment or stimulants, or both, in the 
treatment of exudations. In order to favor excretion of 
the effete matters in the blood, purgatives, diaphoretics 
and diuretics will be found very useful. 

The general indications now alluded to, of course, ad- 
mit of infinite variations and modifications in individual 
cases, but I think will be found infinitely useful in the 
treatment of all exudations or inflammations. 

I have briefly referred to the disease, its pathology, 
nature and treatment, and feel confident that the careful 
and honest student will find them correct in principle. 

EXUDATION CAN NOT BE CUT SHOET. 

I have said in the "treatment" of inflammation or 
exudation, that " if these symptoms are fully developed, 
and the exudation establis7ied, it is not possible to cut it 
short." 

A few words more on this subject may not be consid- 
ered out of place. First, because it is an impression 
among physicians and the people that by a certain 
course of treatment inflammation can, in almost any 
stage, be broken up. Hence means the most heroic are 
often resorted to ; and when they fail (which certainly 
they must) the physician is blamed and charged with 
ignorance, while he concludes himself that he has 
failed to do his duty by not pursuing these heroic means 
to a greater extent, and all parties are dissatisfied. 
Second, because such means, in my opinion, must fear- 
fully increase the mortality in that disease. Third, that 



150 THE FAMILY PHYSICIAN 

I may show that inflammation, when once formed or 
established, runs through a definite course, and also 
show what that course is, and that it is as much an im- 
possibility to cut it short or check it in that course as it 
would be small-pox. Fourth, that the disease is one of 
more importance to the human family than any other, 
for it, doubtless, occasions at least one half of the pre- 
mature deaths in the land. 

A mere statement of the first, second and fourth pro- 
positions are enough, but the third admits of careful 
consideration, which I shall proceed to do briefly. 

There was a time when the practitioner was as confi- 
dent he could arrest or cut short a casa of typhus or 
small-pox, measels or scarlatina, as he is now that he 
can a case of inflammation. 

Apropos of typhus, you hear physicians now talk 
fluently about " breaking up " or " cutting short typhus," 
but the well informed make no such claims. No sooner 
would the thorough physician claim that he could cut 
short typhus or inflammation than he would that he 
could cut short small-pox or scarlatina. "With regard to 
these has been established the principle : first, of pre- 
vention ; and second, when this fails, of simply conduct- 
ing them to a favorable termination. This rule ought to 
hold good with regard to internal inflammation or exuda- 
tion, and I think it will be admitted, if I succeed in 
making it apparent, that when exudation is once formed 
it runs through a definite course, and also what that 
course is. 

If we watch the natural progress of exudation in any 
of the textures of the body we can not fail to observe 
that it terminates in two ways : first, by vital changes of 
growth of different kinds in the exudation, constituting 
what have hitherto been called suppuration, adhesion, 



AND GUIDE TO HEALTH. 151 

granulation, cicatrization, the healing process, &c. ; and 
secondly, by death of the exudation, which, if rapid, 
putrities, producing gangrene, or, if slow, disintegrates, 
causing ulceration. 

Now, this first series of changes are not destructive, 
but formative and reparative. Suppuration especially 
should be looked upon as a kind of growth, which 
enables the exuded and coagulated blood-plasma to be 
rapidly broken up and eliminated from the economy. 
If so, instead of being checked, it should be encouraged 
as much as possible. Every thing that lowers the vital 
strength and weakens the economy must impede the nu- 
tritive process of growth, and tend, more or less, to a 
slow or rapid death of the exudation. 

Blood letting especially has this tendency, and must, 
therefore, be wholly opposed to the rapid disappearance 
of inflammation. 

If a bone is fractured, exudation occurs around the 
injured part and is poured out, which undergoes vital 
changes, whereby, ultimately, it is transformed into 
bone. If soft parts are destroyed or removed, the exud- 
ation poured out from the injured vessels undergoes 
other vital changes, whereby it is transformed into 
fibrous tissue, constituting, first, granulations, and then a 
cicatrix. After subcutaneous section of tendon, with 
separation of its extremities, the transformation is more 
perfect, producing, as in the case of bone, a growth 
exactly similar to the one which was injured. If a 
violent blow or injury has been received, a greater or 
less amount of exudation is infiltrated among the con- 
tused and torn tissues, which is transformed by cell 
growth into pus, which, if it can be evacuated externally, 
is soon got rid of, but if not, is, on the disintegration of 
the cells, absorbed and excreted from the economy. If, 



152 THE FAMILY PHYSICIAN 

under other circumstances, the pns is absorbed as rapidly 
as it is formed, the inflammatory swelling is said to be 
resolved or discussed ; if not, it collects in the form of a 
fluid, and constitutes an abscess. Surely it can not be 
maintained that, in any of these cases, we can favor 
these separative processes by blood letting and lowering 
the strength of the economy? On the contrary, they 
have always been found to be best perfected in indivi- 
duals of vigorous constitutions, whilst in scrofulous or 
broken down and weak persons, they proceed slowly or 
not at all. 

But in internal inflammation, say of the lungs or peri- 
cardium, are the processes different ? Certainly not. In 
the one case the exudation is converted into pus cells and 
absorbed, and in the other into fibrous texture, causing 
adhesions. But because these processes have been hid 
from view, physicians have supposed that instead of 
treating the inflamed parts, as the surgeon does, he 
ought to attack the general symptoms which result from 
the lesion. In cases of fracture and contusion there are 
also febrile symptoms, increased pulse, and so on. But 
does the surgeon imagine that callus will form better, or 
an abscess be resolved, or reach maturity sooner by 
general blood letting and antiphlogistic s ? Experience 
teaches him otherwise. In the same manner it may be 
most reasonably argued that such treatment can not favor 
the natural termination of internal exudations. 

I will point out more particularly the changes which 
pneumonia goes through. In pneumonia the exudation is 
infiltrated into the air vesicles and minute bronchi, and 
between the fibrous blood vessels and nerves of the paren- 
chyma, imprisoning the whole in a soft mass, which 
coagulates and renders the spongy texture of the lung 
more dense and heavy, or what is called liepaMzed. 



AND GUIDE TO HEALTH. 153 

This accomplished, no air can enter. The nerves are 
compressed; the circulation is in great part arrested; 
and the object of nature is now to convert the solid exud- 
ation once again into a fluid-, whereby it can be partly 
evacuated from the bronchi, but principally re-absorbed 
into the blood and excreted from the economy. This is 
accomplished by cell growth. In the amorphous coagu- 
lated exudation granules are formed ; around groups of 
these cell-walls are produced, and gradually the solid 
amorphous mass is converted into a fluid with cells. 
This is called pus. The cells, after passing through their 
natural life, die and break down, and thereby the exud- 
ation is again reduced to a condition susceptible of 
absorption through the vascular walls, and once more 
mingles with the blood, but in altered chemical condition. 

In a pleurisy or a pericarditis the transformations 
occurring in the exudation are different. Let us follow 
them in the case of pericarditis. When a severe inflam- 
mation of the pericardium occurs the liquor sanguinis is 
exuded in considerable quantities, separating the serous 
layers to a greater or less extent. After a time the fibrin 
coagulates and forms a layer which attaches itself to the 
membrane, whilst the serum of the blood accumulates in 
the centre. The coagulated fibrin first assumes the form 
of molecular fibres, plastic or pizoid cells are formed in 
it, others throw out prolongations, so as by their union 
to form a plexus, which, communicating with the vessels 
below the serous membrane, renders the exudation vascu- 
lar. Gradually the surface assumes the appearance of 
a villous membrane, which possesses also the absorbent 
functions of one. 

The enlarged villi frequently contain vacuoles or 
spaces, reminding one strongly of the general structure 
of the placental tufts, than which nothing can be imag- 



154 THE FAMILY PHYSICIAN 

ined more perfectly adapted for the purpose of absorp- 
tion. In consequence the serum now disappears, the two 
false membranes are brought in contact, and thus the 
absorption, as soon as it is no longer required, is put an 
end to and adhesion occurs. The matters absorbed into 
the blood pass through the same series of changes as those 
in pneumonia do, and are eliminated from the economy 
in a similar manner. Such is the natural progress of 
pericarditis. The two kinds of processes now described 
exhibit the same wise design in pathological as we every- 
where find in physiological action. In vascular tissue of 
the lungs new blood vessels are unnecessary; but in 
the non-vascular serous membrane they must be formed 
to bring about removal of the morbid products. In the 
one case the entire exudation is transformed into cells to 
produce rapid disintegration and absorption, which latter 
is easily accomplished by the already formed numerous 
vessels of the lungs. In the other case the exuded liquor 
sanguinis is separated into solid and fluid parts, and as 
there are no vessels in the serous membrane, they are 
formed into one portion of the exudation to cause the 
absorption of the other. During the progress of those 
essentially vital acts and modes of growth and forma- 
tions, how can it be supposed that lowering the strength 
by blood letting can influence these in any way except 
for the worse ; that is to say, by weakening that power 
on which the transformations depend ? Then, in exuda- 
tion as well as in small-pox and typhus, we must not 
destroy the vital forces by trying to cut it short, but use 
the best means in our power to conduct it to a favorable 
termination. Let the mind be disabused in regard to 
the theory of cutting short an established internal inflam- 
mation ; it is a phantom, a myth, the pursuit of which 
will always end in bitter disappointment. 



AXD GUIDE TO HEALTH. 155 

While congestion may be, and often is, broken np, even 
after the beat and redness have appeared, the exndation 
has not taken place, hence the pathological condition 
meant by inflammation really has not been set np. In 
snch cases exudation is prevented, not broken np. I 
repeat, that after it is once established it can not be 
broken np or cnt short, 



156 THE FAMILY PHYSICIAN 



MALARIAL FEVERS. 

OBSERVATIONS OF THE PECULIAR POISON WHICH PRODUCES THEM 

MALARIA THE PRODUCT OF ORGANIC DECOMPOSITION IN SOILS 

— ITS EXISTENCE ASSUMED — WATER INDISPENSABLE TO THE 
PROCESS — MALARIA GENERATED IN HARD ROCKS — MALARIA A 

BLOOD POISON IT IS GENERATED IN THE GREATEST ABUNDANCE 

IN MARSHES. 



The poison which gives a distinctive name to fevers 
with periodical returns is every where recognized by the 
term malaria. 

Chemistry has not been successful yet in demonstrat- 
ing the existence of malaria. Its existence is assumed 
from certain observed effects on the system or organism, 
just as we do in the case of other poisons which produce 
certain specific diseases. In this article it is intended 
only to briefly summarize the few facts relating to this 
poison which have been tolerably well ascertained. 

Malaria is believed to be the product of organic decom- 
position in soils ; whatever may happen to be their min- 
eral composition, water is indispensable to the process, 
and a high temperature, although not absolutely neces- 
sary, greatly aids it. It is generated in greatest abund- 
ance in marshes which contain a high percentage of 
organic matter, hence the name by which it is familiarly 
known, mz. marsh miasm. It is also said to be gener- 
ated in hard rocks, such as granite and trap, in a disin- 
tegrated state. " A notable example," says Dr. W. C. 
Maclean, " is the island of Hong Kong, which consists 



AND GUIDE TO HEALTH. 157 

entirely of weathered and decaying granite. In such 
soils, so long as they are undisturbed, the existence of 
malaria may not be suspected. In the case of Hong 
Kong, for example, it was not nntil extensive excava- 
tions were made into the disintegrating granite, for build- 
ing purposes, that violent and fatal remittent fevers 
appeared.'' The air of marshes, known for ages as 
malarious, has been examined by chemists. Watery 
vapor and carbonic acid are always found in excess, and 
under certain conditions, sulphuretted hydrogen. And 
Parks says, " Carburetted hydrogen is often present, and 
occasionally free hydrogen and ammonia, and, it is said, 
phosphoretted hydrogen." Besides the above, " various 
vegetable matters and animals, floating in the air, are 
arrested when the air of marshes is drawn through water, 
or sulphuric acid and debris of plants, infusoria, insects, 
and even, it is said, small Crustacea are found." 

Malaria acts with the greatest intensity on the human 
system in situations which are low and moist, abounding 
in vegetation undergoing decomposition, e. g., in jungly 
districts, during or immediately after the rainy season, 
at the base of great mountain ranges and along the 
course of small rivers, particularly if their bottoms are 
low and covered with vegetation. 

Malaria is capable of drifting along plains for a con- 
siderable distance from its source, particularly in the 
direction of the prevailing wind. It is said to ascend 
mountains, especially when favored by ravines and cur- 
rents of air. 

It is a common belief in India that water is capable of 
absorbing malaria, and that periodic fevers, dysentery 
and even cholera are produced by drinking water so 
charged. This absorbing power of water has quite a 
beneficial effect, particularly when a sufficient breadth of 



158 THE FAMILY PHYSICIAN 

it is "between our habitations and the source of the poison. 
Belts of trees, in like manner, exercise a protective 
influence. 

Malaria disappears "before cultivation and subsoil 
drainage, with free exposure of the soil to the action of 
the air and of living vegetation. When, however, the 
cultivating hand of man is withdrawn and the old condi- 
tions reappear, malaria again resumes its sway. 

It is the cause of intermittent and remittent fevers and 
their sequels; it underlies the cause of dysentery and 
cholera, and by its depraving influence on the constitu- 
tion it often silently undermines the health without the 
manifestation of any febrile phenomena. 

When a person has for some time suffered from the 
toxic (poison) influence of miasm a curious impress of 
periodicity is sure to show itself in all his subsequent 
ailments, whatever be their nature; and "I believe," 
says Maclean, " from extensive observation, that this 
impress of periodicity in never eradicated." 

Casorati, a late Italian physician of eminence, in his 
" Treatise on Intermittent Fevers," a posthumous work 
lately published, has given it as his opinion " that miasm 
is the cause of an extremely small number of intermit- 
tent fevers." He says that there are " pernicious inter- 
mittents, the origin of which is simply rheumatic." He 
further says that, within the sphere of his observation, 
" Nothing is more common than to see pregnant women 
the subjects of tertian fever, under which they frequently 
abort," and he gives numerous examples of disease, such 
as menorrhagia, cephalalgia, &c, &c, all presenting an 
intermittent type, due, as he supposes, not to the toxic 
effect of miasm, but to other causes, such as " humidity," 
" cold," and the like. The truth is that Casorati's sphere 
of clinical observation was in a malarial region; the 



Al^D GUIDE TO HEALTH. 159 

stamp of periodicity was therefore deeply impressed on 
a great number of the diseases that came under his care. 
The proof of this is not far to seek, for, "by his own show- 
ing, no treatment was effective until quinine was given. 
"We do not find," says Maclean, "when there is no 
miasm to complicate the case, that ' acute rheumatism,' 
or ' menorrhagia,' or ' cephalalgia ' derive "benefit from 
anti -periodic remedies, still less that such are indispen- 
sable to all treatment." No sooner is the blood poisoned 
by malaria than it acts on the stomach and alimentary 
canal. In all agues, particularly of a severe type, there 
is, from the first, great disturbance of the stomach, and 
in severe remittents this is often the most prominent and 
urgent symptom. Casorati goes so far as to state that 
morbid appearances in the stomach constitute by far the 
most constant post mortem appearance found in fatal 
cases of intermittent fevers. Maclean gives it as his 
opinion that malaria is often the cause of dysentery, and 
says, " In the present state of knowledge it is not possible 
to explain why malaria should in one case cause dysen- 
tery, and act with intensity on the glandular structures 
and mucous membrane of the great intestine, and in 
another excite an intermittent or remittent fever, with 
signs of extreme irritation of the stomach and duodenum, 
going on often to structural changes in those parts." 
Chemistry may one day reveal to us some difference, at 
present inappreciable, in the constitution of miasmata, 
to account for the affinities displayed in the different 
cases. Cases occur sometimes that at first it is difficult 
to tell whether they are going to be dysentery or remit- 
tent fever. The structural changes of a more secondary 
kind induced by malaria are enlargment of the spleen 
and liver. 



160 THE FAMILY PHYSICIAN 

INTERMITTENT EEVEE — PERIODICAL EEYEE — AGUE — PAL- 
UDAL FEVER — CHILLS AND FEVER — COLD FEVER. 

The intermittent fever is a specific paroxysmal fever, 
the febrile phenomena observing a regular succession, 
characterized by a cold, a hot and a sweating stage, with 
intervals of comparative good health between the par- 
oxysms. 

SYMPTOMS. 

A person. who has been exposed to malaria will gen- 
erally, sooner or later, begin to suffer from premonitory 
symptoms. Many, however, have their constitutions 
silently undermined without suffering from periodical 
fever at all. It seems probable in such cases the poison 
is not presented to the system in a very concentrated 
form ; the blood is so gradually changed that the organs 
become tolerant of its presence, to such an extent at least 
that febrile phenomena are not excited at regular inter- 
vals for the apparent purpose of expelling it from the 
blood. On the other hand, people in perfect health may 
be exposed to the action of malaria in such a noxious 
form as to be at once completely overwhelmed by it. 
Cases are not wanting of parties being attacked by in- 
termittent fever in its worst form in less than twenty-four 
hours after having spent a night in some well known 
malarial district. After having been exposed to malaria 
— and here allow me to say that I do not believe a genuine 
well marked case of intermittent fever was ever pro- 
duced by any other cause than malaria — the toxic in- 
fluence is evidenced by some degree of nausea and loss 
of appetite, with muscular pains in the back and lower 
limbs, with usually a slight feeling of chilliness, soon 
passing into trifling heat of the skin, scarcely marked 
enough to excite attention. This may recur for several 



AND GUIDE TO HEALTH. 161 

days before a regular paroxysm of ague sets in. Or, 
without such prolonged warnings, after an hour or two 
merely of the above symptoms, the patient may be 
seized with the cold stage. 

I have said that I did not believe a genuine well marked 
case of intermittent fever was ever produced by any 
other cause than malaria. The exciting cause is un- 
doubtedly an exhalation from the soil, given off under 
conditions already described, to which the name malaria 
is provisionally applied. In support of that opinion I beg 
leave to quote from Dr. W. C. Maclean, one of the very 
cleverest English writers, and a gentleman who seems 
to have given much attention to the subject; he has 
studied in India, where the disease presents itself in all 
its forms and degrees, and where every phase of country 
is to be found as regards malarial and non-malarial dis- 
tricts. The Dr. says, " That specific agues ever arise 
from other causes than malaria I do not believe, and am 
satisfied that where they are attributed to • cold,' to 
' moisture,' to 'irritation,' to the 'influence of the mind,' 
and such like supposed causes, it will in every such 
instance be found that the sufferer has at some former 
period been in a malarial locality, or that this poison, 
arising it may be from an unexpected source, has been 
in operation just before the attack." He further adds : 
"In a most especial manner I desire to express my entire 
dissent from the doctrine that specific agues are the 
result of suppressed cutaneous secretions under sudden 
impressions of cold. If it were so we should have agues 
constantly occurring in temperate climates during the 
summer months in places where no miasma exists, which 
is contrary to all experience. When this poison has 
been introduced into the system suppressed cutaneous 

secretions, under sudden impressions of cold, may call 
11 



162 THE FAMILY PHYSICIAN 

the poison into action, perhaps by concentrating it more 
in the gastro-dnodenal mucous membrane during the 
state of congestion that follows the impression of cold; 
but to produce a true specific ague I believe the presence 
of malaria in the Mood to oe necessary P [The italics 
are mine.] He further says : " To the question, why 
miasmatic poison, unlike that of rheumatism, or variola, 
or typhus, should produce a periodical and not a con- 
tinued fever, no satisfactory answer has yet been given ; 
notwithstanding all the ingenious speculations of scien- 
tific inquiries, it remains unexplained." 

But to return to the symptoms. There are three stages 
which characterize this disease, termed the cold, the hot 
and the sweating. 

After certain premonitory symptoms, of which the most 
prominent are nausea, languor, lassitude, muscular pains 
in the back and legs, the cold stage commences. In this 
the patient becomes chilly, first in the extremities, then 
in the back, and soon passes into a most unpleasant 
sensation of coldness over the whole body. The skin 
shrivels, the nails become blue, and rigors more or less 
severe rapidly succeed each other. On the very warmest 
days and in the hottest climate the patient demands 
more bed clothing, or if the paroxysm is not so severe as 
to force him to bed, he will place himself as close to the 
fire as possible and sit over it and shake. I have been 
pained to see poor little children crouching in a corner 
near the fire shivering, with their little blue lips and 
nails, demanding draught after draught of cold water 
and vomiting it up again even before it was warm in the 
stomach. The writer of this article has at this moment 
plainly impressed on his mind the feelings above de- 
scribed, having been a victim a great number of times in 
early life to intermittent ; but for a great many years 



AND GUIDE TO HEALTH. 163 

past lie has escaped tlie disease by using a preventive. 
Like the rattlesnake's warning the premonitory symp- 
toms produce the unpleasant knowledge that danger is 
nigh, even at hand, and, like the affrighted woodsman, 
when he hears the fearful sing of that dangerous reptile, 
we try to escape. Our way of escape, however, does 
not lie in the same direction, for while he takes himself 
away from the snake, I destroy the poison "by the use of 
a full dose of quinine, and by that means escape alto- 
gether the disagreeable disease. 

The sensation of cold of which the patient complains 
is merely a subjective symptom. Incredulous as the 
shivering patient may be it is certain that the tempera- 
ture of his blood, even before the chill, is above the 
natural standard. 

The duration of the cold stage is variable ; it may last 
for half an hour to two or three hours, and in rare cases 
more. 

Hot Stage — Flushes of heat at first alternate with 
slight rigors, by and by a grateful feeling of warmth 
steals over the whole body, and the bed clothes are thrown, 
off; the increase of temperature is now apparent to the 
patient and his attendant. The pulse becomes full and 
frequent. The respiration, though still hurried, becomes 
more regular. The agreeable sensation that accom- 
panied the first feelings of warmth passes away ; nausea, 
and even vomiting, often distress the patient. Headache 
and thirst are complained of, and the patient tosses 
uneasily in a burning fever. The duration of the hot 
stage varies in accordance to the attack ; it may only last 
an hour or two, or from two to eight or ten hours. 

Sweating Stage — Perspiration commences on the brow 
and extends over the whole body, until the patient 
sweats freely at every pore. The pulse and temperature 



164 THE FAMILY PHYSICIAN 

rapidly fall to the normal standard, and the interval or 
intermission from which the fever takes its name has 
commenced. The types of the fever are also named 
from this interval, or rather the length of it. These 
are the quotidian, which recnr daily, and this is the 
primary disease and the form in which it almost always 
commences. The textian is the name given to that form 
in which there is a paroxysm every other day, and quar- 
tan every third day. 

The blood is changed from the "beginning of the attack? 
and, probably, from the exposnre to the malaria. 

Most cases of intermittent will end, if left entirely to 
nature and a proper diet, in from ten to fonrteen days. 
Its termination if left to nature and a good diet is inva- 
riably favorable, if uncomplicated. It, however, by im- 
prcyper food, exercise or exposure, is very subject to 
relapse, and often leads to other diseases, its complica- 
tions with which cause death, even under judicious treat- 
ment. Hence the great necessity for prompt treatment 
and proper care. 

TKEATMENT. 

" Happily for us," says the observant traveler, Barton, 
" the old African treatment is now obsolete. A. B. caught 
fever — gave him calomel, bled him, blistered him — died 
on the third day." 

Happily, too, for those whose lot is cast in the malarial 
districts of the United States, and even India, the same 
may be said ; the antiphlogistic treatment of malarial 
fevers is no more. So completely is this the case that it 
seems to me like contending with a shadow to say a 
word in condemnation of it. In Italy ague is still looked 
upon as an inflammation and treated by general and 
local bleedings, low diet, &c. 

Speaking of this system of treatment in malarial 



AND GUIDE TO HEALTH. 165 

fevers, a clever writer says, " Formerly when an inflam- 
mation manifested itself it was regarded as something 
superimposed npon the organism — as an enemy attack- 
ing the fortress of life, which required to be attacked Iby 
the most energetic measures." 

" Its supplies must be cut off ~by the enforcement of 
rigorous diet, and it must be attacked by the heavy 
artillery of bleeding, mercury and blisters." 

" But it was not kept in mind that by these measures 
the garrison was weakened in an equal degree with the 
enemy, or rather in a greater degree, so that even if the 
adversary were overcome and retired from the contest, 
the patient often succumbed, owing rather to the severity 
of the treatment than to the malignancy of the disease." 

During the cold stage or chill, if the tongue is foul or 
the stomach oppressed by food, reaction is hastened and 
the system placed in better condition to receive the treat- 
ment by the use of an emetic ; this can be accomplished 
by the use of twenty grains of ipecac in three or four 
ounces of water. Under ordinary circumstances it is not 
at all necessary to give an emetic. My rule, how- 
ever, is never to give an emetic unless I find the stomach 
overburdened with food, that is, unless I find the patient 
has ate heartily just before the chill; then it is better to 
relieve the stomach ; reaction will be had sooner and 
there will be less nausea during the hot stage and it will 
be shorter. But, I repeat, an emetic is not necessary 
unless to relieve the stomach from an overburden of food. 
The same rule may be regarded as to purgatives ; unless 
the bowels are loaded I would never recommend a 
purgative, not even a dose of citratized magnesia or 
Seidlitz powders. If the bowels are loaded a purgative 
of this class will not only relieve them of the accumula- 
tion, but its action will relieve the congested condition 



166 THE FAMILY PHYSICIAN 

of the solid abdominal viscera and prepare the way for 
the action of quinine, which is the remedy. Dr. Maclean, 
of London, says in regard to quinine : "In quinine we 
have a remedy, if skillfully used, particularly in first 
attacks, which almost deserves the epithet, ' divine,' 
which has been applied to it." 

Then it will be observed that I do not recommend the 
use of either emetics or cathartics in the treatment of 
ague, unless they are specially indicated by the stomach 
or bowels being overloaded. 

There is often present one symptom that I failed to 
mention that sometimes needs attention. I refer to 
urinary irritation ; this is often a troublesome symptom, 
during the chill especially. This can be relieved at once 
by giving a dose of bicarbonate of potash with ten drops 
of laudanum. It may always be assumed that the first 
attack is of the quotidian type, or a paroxysm every 
day, and measures may be taken accordingly ; and if the 
patient gets twenty-five or thirty grains of quinine be- 
tween the time of the sweating stage and one or two 
hours before the same hour arrives next day that marked 
the time of the first paroxysm, it may be very safely 
calculated that he will not have a second paroxysm. 

The best way to administer quinine for chills is in a 
fluid state, with a few drops of diluted sulphuric acid 
(elixir of vitrol) in it; of this enough should be given 
about the termination of the sweating stage, or before, for 
the patient to get ten grains ; the balance at equal inter- 
vals, calculating the time so the patient shall get the last 
dose at least two or three hours before the time at which 
the chill began the day previous. If the solution of 
quinine is given the bitterness is best covered in a little 
syrup of orange peel, and if this is not at hand, in coffee, 
cold. If the patient objects to the use of the solution of 



AND GUIDE TO HEALTH. 167 

quinine it may "be given in pills or in powder wrapped 
in jelly, preserves or fruit; but for an adult try and 
always use about thirty grains — never less than twenty — 
and for children in proportion. There is a great preju- 
dice in the minds of the people against quinine, and I 
have heard some say they had been so much injured by 
its use that they could often feel its effects in their bones. 
Such persons, of course, know nothing about it or its 
nature, for any man who does know anything at all of 
it knows that no such effects can be charged to it, and 
any medical man who has any regard for his head or 
heart must say that it is one of our most innocent and 
harmless remedies, and one that in malarial and all 
periodical disease is the richest blessing found in medi- 
cine to the human race. If you have any prejudice 
against the article, even if it is founded on or confirmed 
by experience, lay it aside and take the judgment 
of all sensible, honest medical men, whose verdict is 
unanimous in its favor. It is a safe and effective article 
for the infant a fortnight old, for the strong man of thirty, 
and for the grey -haired father of three score years and 
ten. Prejudice against the use of quinine or against 
quinine only arises from ignorance in regard to the 
article and its, properties. 

If the stomach is so irritable that the medicine can not 
be retained in it, no time should be lost ; fifteen grains, 
in some beef tea or in four ounces of starch water, should 
be given by injection, after first washing out the rectum 
by an injection or two of warm water. These injections 
of fifteen grains of quinine should be repeated often 
enough for the patient to get at least fifty or sixty grains 
before the time for the next paroxysm, in which case it 
is not likely the paroxysm will occur; if, however, it 
does, the same course should be pursued after it that has 
been recommended after the first. 



168 THE FAMILY PHYSICIAN 

If the paroxysm is prevented it is best, and should 
always be practiced under all circumstances, to give the 
patient enough quinine for a day or two to keep him 
under its influence; this may be done by giving him 
three or four grains three times a day. Much depends 
upon the effectual treatment by quinine in this complaint ; 
the poison should be effectually destroyed, and it can only 
be done and the periodicity broken up by the use of 
quinine. But our duty to our patients is not yet dis- 
charged. In a lunar month (four weeks) from the date 
of his first attack, even should he not in the interval be 
exposed to malaria afresh, there will be a tendency in 
his system to repeat the same phenomena as before, and 
this tendency will be strengthened by every successive 
attack. A day or two, then, before the time the patient 
should again be brought under the use of quinine, which 
should be maintained until that time is past. 

Cases are occasionally met with in which quinine 
seems to have lost its control over the malarial poison, 
the attacks returning month after month, notwithstand- 
ing the prophylactic use of the antidote. In such cases 
it will be found that the sufferers have been long in a 
malarial district, and that there is some enlargement of 
the liver or spleen. In such cases the fluid extract of 
toraxicum, with small doses of podophyllin, are most 
useful ; and if to the above be added, for some days, the 
free use of bicarbonate of potash well diluted, it will be 
found that quinine, before useless, will soon reassert its 
power. 

Next to quinine, for the treatment of intermittent s, 
stands arsenic. This article, different from quinine, is a 
dangerous one, and one which if used at all should be 
with great care. It is safe, however, to administer it in 
the form of Fowler's solution for the cure of ague, in doses 



AND GUIDE TO HEALTH. 169 

of ten drops three times a day for three or four days. 
If it is administered a careful lookout should he kept 
for its earliest signs of constitutional action, which are 
watering of the mouth, a silvery appearance of the 
tongue, redness of the eyes ; when these appear it must 
not be continued. I have cured some very old and bad 
cases of chills with this article ; but when quinine can 
be had there is certainly but little use for any other 
article. Arsenic is sometimes used because it is so 
cheap. It enters into many of the patent nostrums that 
are vended for the cure of ague. They should be 
touched with great caution. 

The diet in this complaint and during convalescence 
must be good, easy of digestion and nutritious, with the 
use of good wine or brandy. Burton says : " People 
will act up to the old nursery saying, ' Starve a fever, 
feed a cold.' My experience in East Africa long ago 
untaught me that tenet. I have ever since preferred to 
support exhausted nature with essence of meat and beef 
tea, and, when such things are procurable, with cham- 
pagne, brandy, cum soda, and ye oldest Hock in ye 
cellar." Dr. Blair is quite as explicit on this point as 
Burton, as well as Drs. Bennett, Maclean and Morehead. 

In the course of an intermittent fever, cerebral, pul- 
monic, hepatic and gastric complications may occasion- 
ally be expected. "After no small experience," says 
Maclean (Reynold's System of Medicine, page 66, vol. 1), 
" I unhesitatingly say that the occurrence of drowsiness, 
mental confusion, suffusion of countenance, and such 
like symptoms, should not mislead us into the use of 
routine remedies directed against them. Let all our 
efforts be used to cure the fever, to stop the paroxysm, 
and to the due support of our patient. When these 
objects are attained the head symptoms will disappear. 



170 THE FAMILY PHYSICIAN 

In like manner, the presence of cough, or asthma, or of 
hepatic congestion, should never influence us to lay 
aside quinine and the other means recommended above, 
in order to direct routine treatment to counteract this or 
that incidental symptom occurring in the course of a 
malarial fever. Those who do so often put the lives of 
their patients in great peril." 

" Practitioners who omit the use of quinine from a 
groundless fear of aggravating such symptoms, and sub- 
stitute strong measures of a so-called antiphlogistic 
kind, applying leeches and cold to the head, giving 
nauseating expectorants and purgatives, merely because 
of the head symptoms already mentioned, the presence 
of some bronchitic rales and cough, or some tumefaction 
of the side, will not only have little success in the treat- 
ment of malarial fever, but will aggravate the symptoms 
they seek to cure, hasten alarming exhaustion or bring 
on sudden collapse." 

A nutritious diet, plenty of moderate exercise, pure 
air and pure water are powerful curative means, and 
must never be lost sight of in the treatment of disease. 
This is a fact that has been long overlooked, but is now 
being given the attention of the great lights in medicine. 



AND GUIDE TO HEALTH. 171 



REMITTENT FEVER. 

SYNONYMS: BILIOUS EEVER — BILIOUS REMITTENT — EPI- 
DEMIC FEVEK — MARSH REMITTENT — GASTRIC MALA- 
RIOUS — REMITTENT JUNGLE FEVER. 



The great number of names that have been given to 
this fever has always confused the minds of the common 
people, who have imagined that each name belonged to 
a different and distinct fever, as in the case of intermit- 
tent, typhus, &c. This, however, is not the case. They 
are all one and the same, and I shall only use the name 
remittent fever , which may be defined as a strict specific, 
paroxysmal fever, with exacerbations and remissions, 
characterized by a slight and ill- defined cold stage, 
which does not recur at every exacerbation (increase of 
the fever) ; an intense hot stage, with violent headache 
and gastric irritation (irritation of the stomach) ; and 
an almost imperceptible sweating stage, which is indeed 
sometimes wanting. 

Remittent is the gravest form of true miasmatic fevers. 
It has been observed wherever malaria is generated in 
sufficient concentration, both in hot and in temperate 
climates, but it is most prevalent and fatal when high 
temperature and malaria act in combination. 

It is found in America, North and South, prevailing 
chiefly, with varying degrees of severity, in the vast re- 
gions between the northern lakes and the Gulf of Mexico. 



172 THE FAMILY PHYSICIAN 

Remittent fever is a more serious disease than any type 
of intermittent, and is easy to distinguish from that dis- 
ease by intermittent having a complete apyrexia (free- 
dom from fever) between the paroxysms, while in remit- 
tent the defervescence is not complete. The more urgent 
symptoms between one exacerbation and another abate ; 
in some cases this abatement is well marked, in others it 
is so slight that the period of so-called remission may 
escape the notice of all but the careful observer. 

Remittent fever, as we have seen, has many synonyms, 
but there is one the use of which I earnestly deprecate 
viz. : inflammatory remittent. This is used by some 
authors and practitioners in the belief that the terrible 
disturbance of the vascular and nervous systems is due 
to a genuine phlogasis (external inflammation). This 
view is not based on the true pathology of the disease, 
and is calculated to mislead in the treatment of it. I 
recollect very well when I was about fourteen years old I 
was attacked with this disease, and the doctor, who stood 
at the head of the profession in that part of the country, 
pronounced my disease " inflammatory fever." Taking 
this view of it he bled me profusely, almost to fainting, 
each day for three successive days, and gave me mercury 
in the mean time, without either nourishment, stimulant 
or tonic, allowing me only a little warm water to quench 
the thirst that was consuming me. How well now, after a 
lapse of more than a quarter of century, do I recollect 
the intensity of that thirst, and how well do I recollect 
the touching appeals I tried to make to my kind, doting 
father and mother and the doctor for only one swallow of 
cold water ; but no, the doctor, although a truly tender 
and good hearted man, would shake his head and say, 
one swallow of cold water would kill you. After the 
third day the bleeding was left off. At the commence- 



AND GUIDE TO HEALTH. 173 

ment of the attack the doctor had placed five blisters 
upon me, one very large one on my stomach, two smaller 
ones on the calves of my legs, and two on my arms just 
"below the elbow. This blistering was frequently renewed, 
and the mercurial treatment, with the use of spirits of 
nitre, kept up. I had a powerful constitution, one that 
seems to me must have been of that class that we fre- 
quently hear termed " an iron constitution." In about 
six or seven weeks it overcame the disease and the rem- 
edies, which were worse, and I began to improve, but it 
was many weeks before I could walk. This is only a true 
history of the mistake of calling remittent fever inflam- 
matory fever, and treating it on the antiphlogistic prin- 
ciple ; it is the history of almost every case, and repeats 
itself every season now in the United States ; true, most 
all of the leading physicians of the present day depre- 
cate such a course, but there are yet many to be found 
all over this great country of ours who still torment their 
patients and aggravate the disease by this pernicious 
antiphlogistic regimen. 

SYMPTOMS AND MODES OF COMMENCING. 

As in all paludal fevers, so in this, symptoms of gastric 
irritation are the first evidence of approaching disorder. 
The patient complains of anxiety, weariness, nausea, 
languor and lassitude ; uneasiness, sometimes amounting 
to great oppression about the stomach, is, perhaps, the 
most constant, as it certainly is the most distressing, of 
the signs of an approaching attack of remittent fever; 
it is sometimes present for twenty-four or thirty-six 
hours before the setting in of the cold stage. 

The cold stage is neither so long nor so complete as in 
ague ; in fact, sometimes there is only a passing sensa- 
tion of chilliness, alternating with flushes of heat. 



174 THE FAMILY PHYSICIAN 

In other cases rigors are present, hut they are seldom 
severe ; here, as in ague, those sensations are of cold, 
and merely subjective, the thermometer, if placed under 
the arm, indicating a temperature of 2° above the 
natural standard, which, as the hot stage develops, 
amounts to about 8°. As the hot stage advances 
vomiting often begins, and continues throughout the dis- 
ease a distressing symptom. The sense of fullness about 
the stomach is not relieved by vomiting, although the 
amount of fluid thrown off is sometimes large. The 
tongue is furred, and, as the temperature of the body 
rises, is dry. The pulse, which in the premonitory stage 
was slow, small and irregular, now rises rapidly to 100 
or 120, and is in one of sthenic habits full ; in feeble 
persons it is frequent, but small and compressible. 
The countenance is flushed, the eyes suffused, and the 
patient complains of rending headache, with pain in the 
limbs and loins ; the skin is red and distended ; the heat 
ardent and stinging ; the sufferer is restless and tosses in 
his bed in the vain hope for an easy posture. 

When the above symptoms have lasted from six to 
twelve hours they begin to abate ; a very slight degree 
of moisture breaks out on the brow and neck and gra- 
dually spreads over the body ; the pulse comes down a 
little in force and frequency ; the heat of the skin dim- 
inishes ; there is some relief of headache ; vomiting 
ceases, and the patient obtains some sleep. This is the 
period of remission that makes the character of the 
disease. This remission generally takes place the next 
morning after the attack. There is sometimes, also, a 
remission in the evening or night, but the morning remis- 
sion is always the most distinct, and is looked for by the 
experienced physician with much anxiety, for during 
that brief term he expects to disarm the disease of most 



AND GUIDE TO HEALTH. 175 

of its terrors, by destroying part at least of the malarial 
poison ; for this disease, like intermittent fever, is cansed 
by malaria, and in no other way. 

After a respite of some hours, varying from two to six 
or eight — seldom so long — the fever returns, often without 
a chill, or one so slight as hardly to be noticed, and 
all the above symptoms return in an aggravated form. 
This is technically called the exacerbation, which in due 
time passes into the remission again. 

This disease is dangerous just in proportion as it 
resembles a continued and not a paroxysmal fever. 

Death from an uncomplicated remittent fever ought 
not to occur, and under proper management it will not. 
Even in ardent cases in sthenic constitutions (if, indeed, 
there are such constitutions — the word is here used to 
denote great excitement,) the prognosis is favorable ; 
also even in adynamic cases. 

TREATMENT. 

The time-honored practice has been to commence the 
treatment of all fevers with an emetic, and particularly 
this form. "Without any desire on my part to be thought 
curious or acting merely to be in opposition to others, I 
claim that this course is unnecessary, for vomiting in a 
great majority of the cases will require to be checked 
rather than encouraged. It is often the most trouble- 
some, as well as the most exhausting, symptom through 
the whole course of the disease. The disease is not an 
inflammatory one, therefore bleeding and antiphlogistic 
remedies have no legitimate sphere of action in the 
contest. 

The treatment, after the room has been well ventilated 
and the patient made as comfortable as possible, may 
be commenced by giving him a full dose of calomel and 



176 THE FAMILY PHYSICIAN 

rhubarb ; if an adult, say ten grains of each, and recol- 
lect to give citrate of magnesia, Seidletz powders or salts 
in eight or ten hours if it does not act on the bowels. 
Plenty of iced water or iced lemonade should be allowed 
the patient at any period of the disease. After the 
cathartic it will only be necessary to keep the bowels 
regular by some simple means, taking care not to purge 
freely any more. 

If there is great pain in the head cold applications 
must be made to it, but care must be taken that such 
applications do not act, as most often they do from care- 
lessness, as a warm fomentation. Cloths are often 
folded thick, and wet even in cold water, and placed 
upon a patient's head, where they are allowed to remain 
until they really are as a hot fomentation. From this 
fact alone I have often forborne to recommend their use. 
The proper way to apply cold to the head is, first to clip 
the hair close, then pour a small stream of cold water 
upon it, having it placed over a basin to catch the water. 
But if ice can be had, let it be beat fine and placed in a 
bladder or a bag made of oiled silk and applied to the 
head. If cold can be applied in either of these ways it 
will be found beneficial. 

The heat of the body can be reduced by the use of a 
tepid sponge bath, to which a little soda or saleratus 
may be added. The nausea and vomiting may be 
best treated by allowing the patient a little ice to chew 
and swallow, or a lump may be placed in the corner of 
a handkerchief and he be directed to suck it. There 
may be also a mustard plaster placed over the stomach. 
I am not, however, much in favor of such applications ; 
where there is great febrile or nervous excitement it is 
likely to increase them. A fourth of a grain dose of 



AjS"D guide to health. 177 

morphine will generally relieve such cases about as well 
as anything I know. 

Treatment during the remission. — The treatment re- 
commended by Dr. W. C. Maclean, of England, so com- 
pletely meets my unqualified approbation that I shall 
incorporate it here in his own language : " On the first 
signs of this (the remission), as soon, that is, as moisture 
appears, and the heat of the skin abates, and the pulse 
comes down in force and frequency, quinine should be 
given in effective doses of not less than ten grains. I 
have given fifteen often ; twenty sometimes. I am no ad- 
vocate of excessive doses, and any quantity over twenty 
grains I deem to be excessive. I am never deterred from 
giving quinine merely because, even in the intermission, 
there may be headache or foul tongue. Experience 
has taught me that the best remedy against those 
conditions is the one that acts on the toxic (poisonous) 
agent that is the primary cause of all the disturbance. 
I am never deterred from giving quinine because the 
remission is slight. So soon as I am satisfied that there 
is an abatement of symptoms I proceed to give the 
remedy, in the full belief that if I make a skillful use of 
those golden moments of remission, however slight they 
may be, I shall be rewarded at the end of the second 
exacerbation with one more distinct and perfect than the 
first, knowing also that if through timidity I suffer the 
first remission to pass unimproved, the next may be 
more faint, unsatisfactory, and difficult to recognize. I 
by no means wish to imply that there is always so much 
difficulty in recognizing the remission. I desire only to 
guard the inexperienced against expecting to find the 
remission always so distinct as we find it described in 
books. If quinine is rejected, and the irritability of the 

stomach is such that a second dose is also vomited, 
12 



178 THE FAMILY PHYSICIAN 

twenty grains ought at once to Ibe administered in any 
bland fluid by enema. If the stomach retains the medi- 
cine it should be repeated every second hour until 
thirty or thirty -five grains have been taken before the 
hour of the expected exacerbation. Suppose the purga- 
tive has not operated, are we to wait for its operation 
before giving quinine ? I have done so, but finding that 
I lost more ground by delaying quinine than I gained 
by the action of the purgative, I abandoned the prac- 
tice. At the same time I am fully alive to the necessity 
of securing free action of the bowels at as early a period 
as possible. 

"As soon as the second remission appears quinine must 
be given as before, and continued until full saturation of 
the system is evidenced by cinchonism or by a distinct 
abatement of the disease. Ringing in the ears and deaf- 
ness are unequivocal signs of cinchonism. So soon as 
this state is brought about, in a vast majority of instances, 
the exacerbations will become milder and terminate in a 
copious sweat, and the patient will enter into a state of 
convalescence." 

Having ventured to write with so much confidence on 
quinine used in this way, I am glad to be able to adduce 
the testimony of Dr. Davy to the safety of the measure. 
This high authority says " that in the remittent fever of 
the West Indies, during the first quarter after the prac- 
tice was introduced of giving quinine in full doses to 
cinchonism, out of 165 cases only two proved fatal, and 
the record of the post mortem examination in the two 
fatal cases shows that they were rather instances of latent 
phlegmasia than of fever of the true remittent type." 

To this unexceptionable testimony I shall only add 
the evidence of one other observer, of equal reputation 
and experience. The late Dr. David Blair, Surgeon- 



AND GUIDE TO HEALTH. 179 

General of British Guinea, thus expresses himself on the 
question of the safety of quinine : " It has Ibeen prescribed 
by rne to patients of both sexes and all ages, and, when 
ascertainable, almost invariably to cinchonism, during 
thirteen years, and probably to the extent of several 
thousand ounces of the sulphate, and during that time I 
have seen no danger from its effects, with the exception 
of three or four cases of imputed abortion." 

During the remission the patient should have mild 
farina, as milk, chicken tea and such like. As soon as 
the gastric irritability subsides beef tea should be given„ 
and on the first signs of exhaustion nourishments and 
stimulants should be given at short intervals. 

Should quinine ever be given during the exacerbation I 
" In the adynamic (debility of the vital powers) forms of 
the disease," says Dr. Maclean, " such as I described as 
coming from the malarial quarters of the city of Hyde- 
rabad, I never waited for a remission, but gave it at 
once, by mouth or rectum, or both, combining with it the 
assiduous use of support and stimulants at short inter- 
vals. The American physicians led the way in this 
practice and demonstrated its safety." 

Again, when called to cases which have been misman- 
aged in their early stages, either by the neglect of qui- 
nine or the too free use of antiphlogistic means, we must 
act in the same way. There is no time to wait for a 
remission ; the low form of exacerbation then present 
will hourly assume more and more a continued type ; the 
remissions, if they appear, will be of short duration, and 
it will soon be hardly possible to recognize them at all. 
Such cases can only be saved by energetic means, by 
quinine, support and stimulants, given in quantities 
regulated by their effects. In this way most hopeless 



180 THE FAMILY PHYSICIAN 

looking cases may be snatched from the jaws of death, 
as I have seen in a great many instances. 

"What I wrote on the treatment of the complications of 
ague I repeat here emphatically. Practitioners who 
relax in their efforts to stop the exacerbations, who pause 
in the nse of quinine while they apply routine remedies 
for this or that symptom, now applying leeches to the 
head because delirium or headache is present, or to the 
epigastrium because there is some tenderness there, will 
have little success in the treatment of the worst forms of 
India remittent. 

My experience has satisfied me that such symptoms 
are most effectually met by the means which directly 
tend to counteract the poison which is keeping up the 
excitement and disturbing the functions of the organs to 
which it is conveyed by the circulation ; at the same 
time active stimulation of the skin over affected organs 
should not be neglected. It is surprising how much 
relief may be given by sinapisms, turpentine stupes or 
stimulating embrocations without having recourse to so 
double-edged a remedy as depletion. 

Mercury has been largely used in the treatment of 
remittent fever. "When I first went to India," says 
Maclean, " calomel, chiefly in combination with James' 
powder, was used to an extent that, to practitioners of 
the present day, is hardly credible. ' Inflammation' was 
thought to play an active part in this fever, and as calo- 
mel, next to the lancet, was regarded as the most direct 
antiphlogistic remedy, it was used with the intention of 
subduing this inflammation. The end sought was to 
4 affect the mouth,' and quinine, when given at all, was 
only ventured on when this desired consummation was at- 
tained, and then timidly and in utter ignorance of its 
real value and pure therapeutic action. A practitioner 



AND GUIDE TO HEALTH. 181 

of this school in India in the present day would be an 
object of terror to all educated men within reach of his 
prescriptions. 

" Beyond measnre miserable is the spectacle of a man 
whose system, already saturated with malaria, is still 
further depraved by mercurial cachexia. 

" This was the system which, introduced into India 
by the late Dr. James Johnson and some of his follow- 
ers, superseded the admirable treatment recommended 
by Lind and others of his day. The consequence was 
not creditable to our art, and the return to more rational 
treatment, based on a sounder pathology, has been at- 
tended with a signal diminution in the mortality from all 
forms of malarial fevers." 

I have given the Doctor's treatment at length, because 
I do not think a better one or one more in accordance 
with reason and sound principles could be adopted. He 
has pushed quinine to a little greater extent than I ever 
have given it in this disease, but his ten grain doses are 
small enough. It is the only safe course in these fevers. 



182 THE FAMILY PHYSICIAN 



TYPHUS FEVER. 

IN ENGLISH SPOTTED FEVER — PETECHIAL TYPHUS — EPI- 
DEMIC OR CONTAGIOUS FEVER — PUTRID OR MALIGNANT 
FEVER — CAMP FEVER — CONTINUED FEVER, ETC. 



Typhus fever is characterized by an eruption of its 
own, which appears between the third and sixth days. It 
is an acute, specific disease, lasting from fourteen to 
twenty-one days ; it is eminently contagious, and forms 
strongly marked epidemics. 

CAUSES. 

As to the exciting cause of typhus, the great, if not 
the only, one is the specific poison of the disease trans- 
mitted from person to person by contagion, or some thing 
that contains contagious matter, as clothing, bedding, 
&c. Evidence of propagation of the fever by communi- 
cation between the sick is seen in its epidemic spread 
when it enters a community of susceptible persons, and 
even more conclusively in the way in which persons ex- 
posed to none of its predisposing causes catch the fever 
when they are in close attendance on typhus patients. 
Nurses in hospitals where many cases of typhus are 
received are invariably attacked by it, no matter under 
what sanitary conditions they are placed. There appears 
to be no exception to this rule, unless, indeed, it be that 
the nurse is personally unsusceptible of the disease from 



AND GUIDE TO HEALTH. 183 

a previous attack of it. I may remark here, tliat persons 
who have had typhus are not likely to have it again. 
There may be some, but there are very few well authen- 
ticated cases of second attack on record. Medical men 
and Catholic priests in attendance upon numerous typhus 
patients are also almost sure, sooner or later, to get the 
fever, and that they do not fall ill with as much certainty 
or rapidity as the nurses appears to be due only to their 
contact with the sick being less constant and intimate. 
The contagious matter of the disease seems peculiarly 
capable of destruction when it is diluted with air. Thus, 
tolerably close communication with the body of a typhus 
patient appears to be requisite for the reception of con- 
tagion from him. Casual visitors to fever wards very 
seldom get typhus, and in private houses the disease 
rarely spreads even to the attendants ; sometimes, how- 
ever, it does to the whole household. But visitors so 
rarely take it that it should not deter any one from faith- 
fully discharging his christian duty, or doing what James 
defines to be religion. 

There are many instances where typhus fever occurs 
in individuals who can not be ascertained to have been 
exposed to any contagion, and when the readiest explan- 
ation of the occurrence of the fever is, that it has origin- 
ated de novo from the intense operation of its predis- 
posing causes. 

SYMPTOMS. 

The commencement of typhus is generally marked by 
loss of appetite, headache and general malaise. 

The period of incubation is not known, instances being 
so rare of a person taking typhus from a single exposure. 
It is probable that it is only a day or two in some 
cases, and several days in others. For a day or two, 
and in the absence of information respecting exposure, 



184 THE FAMILY PHYSICIAN 

there is nothing to distinguish the outset of typhus 
from that of any other fever, unless it be the absence of 
positive symptoms of other specific illness. It is partic- 
ularly difficult to distinguish an attack of typhus from 
one of acute dyspepsia. Rigors are of frequent occur- 
rence, but they are not so definite or so severe as in 
small-pox or internal inflammation. The sense of chilli- 
ness commonly complained 'of along with the early 
headache may not amount to actual shivering, and is often 
wholly absent. In slight attacks it may not be possible 
to settle the actual time of invasion. In severe cases, 
however, the disease begins very suddenly, with shiver- 
ing, headache, and sometimes vomiting. For three or 
four days the symptoms get worse, and are accompanied 
by sleepiness, heat of the skin and thirst, with unusual 
prostration. The general appearance of the patient will 
help greatly to recognize the disease : he lies prostrate 
on his back, with a most dull and weary expression of 
face, his eyes heavy, and with some dusky flush spots 
uniformly over his cheeks. In the advanced stage of a 
severe attack he lies with his eyes shut, or half shut, 
moaning, and too prostrated to answer questions, to pro- 
trude his tongue or move himself in bed ; or the mouth 
is clenched, the tongue and hands tremble, and the 
muscles are twitching and half rigid. The dryness of 
the mouth, the sordes (foulness) on the teeth and lips, 
the hot, dry skin and the deafness are other symptoms 
which strike an observer so immediately as to deserve 
to be included in the physiognomy of the disease. 

The pulse is accelerated, ranging in mild cases from 
80 or 90 to 120, and in severe cases as high as 140. It is 
generally gradually raised to that height, and seldom 
falls or varies during the whole course of the disease ; to 



AND GUIDE TO HEALTH. 185 

appearance it seems more or less full, "but is easily com- 
pressed. 

The temperature of the body is raised by the third or 
fourth day ; in severe cases it often reaches 105 to 107 ° . 
The maximum temperature is generally attained in the 
middle of the first week, between the fourth and sixth 
Jay. but generally on the fourth day, and then a slight 
but appreciable fall takes place. There is generally a well 
marked remission about the seventh (Jay. In typhus, 
though less than in other forms of fever, there is an 
exacerbation in the evening, and the remission about the 
seventh day is, in some cases, only indicated by the com- 
parative slightness of the evening elevation which then 
takes place. In the more severe cases there is no trace 
of remission at this period, but the temperature main- 
tains itself steadily, or even rises a little. The absence 
of this remission marks the case as likely to be a severe 
one. 

In the second week the temperature rises again, but 
only for a day or two, and scarcely reaches the maxi- 
mum of the first week. * 

Between the twelfth and fourteenth days there is a re- 
mission in both the mild and severe forms of the disease, 
even in cases about to prove fatal. In cases of recovery 
from an average attack defervescence generally occurs 
sometime between the thirteenth and seventeenth days, 
and its approach is sometimes announced by slight exacer- 
bation, which renders the subsequent fall more conspic- 
uous. The return of the normal temperature takes place 
very quickly. In the majority of cases it is complete 
within twenty-four hours, often in twelve hours. It 
begins very frequently in the night ; and the abrupt 
manner in which the fever ceases is one of the peculiar 



186 THE FAMILY PHYSICIAN 

features of the disease, the temperature sometimes fall- 
ing as much as 3 or 4° in the course of a night. 

The eruption, constituting the measly or mulberry 
rash of typhus, is present, at some time or other during 
the disease, in about 95 per cent, of cases, and forms 
the principal diagnostic evidence of the fever. 

It has been described by Jenner and most subsequent 
writers as consisting of two portions, but between the 
two every intermediate link may be found. The one is 
a faint, irregular, dusk-red, fine motling, looking as if 
it lay some little distance below the surface of the skin. 
The other part of the eruption is formed by separate 
spots of small size and purplish color scattered over the 
mottled surface, and looking more or less superficial. 

As a rule, the eruption of typhus appears on the 
fourth or fifth day ; it may appear on the third, and is 
sometimes delayed as late as the seventh. It comes first 
on the back of the wrists, under the arms, and over the 
stomach. 

The tongue in the earlier stages may be unchanged or 
covered with a uniform thick, white fur. As the disease 
advances the tongue becomes dry, the fur forming a 
rough, brown coating over a red mucous membrane. 
Often the tongue is so hard and the whole of the mouth 
so dry that from this cause alone there is difficulty in 
protruding it. At the end of the second week, in favor- 
able cases, the edges get moist and the tongue cleans, the 
fur disappearing moleculaiiy or else in patches, leaving 
the mucous membrane shiny and red. In severe forms 
of typhus, with a variable amount of fur, the dry tongue 
cracks and bleeds, giving rise to black sordes during the 
disease. The tongue may be intensely red and cracked 
without being much furred, and in such cases the charac- 
teristic tongue of typlioid is closely simulated. 



AND GUIDE TO HEALTH. 187 

Diarrhea is a symptom frequently met with in typhus, 
but Dr. George Buchanan thinks it may be generally 
attributed to the treatment. He says it is the practice 
of some physicians to give a considerable amount of 
liquid food, and, in his opinion, this causes the diarrhea. 
But there seems to be some connection between diar- 
rhea and typhus, as patients suffering from the former 
seem to be more subject to the latter. It is often the 
case that costiveness is continued through typhus ; the 
bowels, however, move readily with purgatives. The 
nervous symptoms in typhus are prominent, and it is prob- 
ably through the nervous system that the poison of the 
disease primarily operates. It is from certain of the ner- 
vous symptoms that the name of typhus was originally 
conferred upon continued fever. From the very outset of 
the illness these symptoms occur, consisting in rigor, 
headache, and uneasiness in body and mind. Restless- 
ness and loss of sleep is constant throughout the attack. 
In a large proportion of cases delirium is a symptom of 
typhus. It supervenes generally between the fourth and 
eighth days, the headache going off as the mind begins 
to wander. In severe typhus the delirium passes into 
a heavy stupor and tremulousness of the tongue and 
hands, with twitching of the muscles (subsultus ten- 
denum), is then commonly observed. 

The mortality in typhus, taking all classes and all 
ages, should not exceed ten per cent. This, however, 
depends much upon the treatment. 

TKEATMEISTT. 

In a well written article on Typhus by the clever 
writer, Dr. George Buchanan, he discourses as follows : 
" Typhus fever, like other diseases of its class, can not 
be cured nor its duration shortened by any means at 



188 THE FAMILY PHYSICIAN 

present known to medical science. Its symptoms may 
be combated and its complications may be healed while 
the patient's strength is supported through the time of 
the fever, but we know of no way of counteracting the 
specific disease. Upon a full recognition of this truth 
the treatment of a case of typhus will be most satisfac- 
torily based. If we propose to ourselves to give the 
patient the best possible opportunity of recovery our 
treatment will be more successful than if we direct our 
efforts to cutting the disease short by any supposed 
methods of cure." 

In a disease which lasts two or three weeks, in which 
the metamorphosis of tissue is increased and in which 
ordinary food can not be taken, the patient must be 
kept up by nourishment appropriate to his new condi- 
tion, or he will die, as a healthy person deprived of food 
for the same length of time would die. The essential 
part of the management of typhus consists in giving 
this appropriate nourishment, and in preventing the 
patient dying from the want of it while the curative pro- 
cesses of nature are going on. 

Here, as in many other cases, we must depend upon 
that vis naturae medicatrix, and we must sustain the 
system, remove what objections we can and palliate the 
symptoms while that unerring process is going on. If 
we undertake to "break up the disease," as is often 
unhappily the case even in our day and time, we only 
increase the danger of our patient without the shadow 
of a chance to accomplish our object ; we had as well try 
to break up a case of small-pox, and the attempt would 
not be followed with such evil consequences as would 
the attempt in typhus, while we would stand as much 
chance to accomplish our object. 

For the poisoning by malaria we have our antidote — 



AND GUIDE TO HEALTH. 189 

quinine is a specific in malarial disease. Hence in 
intermittents or remittents we can cure or break up the 
disease. Science lias not discovered any antidote for 
measles, smal-pox or typhus, and I think I may add for 
any other specific contagions disease. There is a long 
list of those diseases, including some. that are not con- 
tagious, that have their certain course to run, among 
which may be included inflammation. In all this class of 
diseases the great principle must be to aid, support, sus- 
tain and assist nature, the grand object being to carry the 
patient safely through the natural course of the disease. 
Any departure from this fundamental principle works an 
injury to the patient and only serves to make men skep- 
tical in medicine. With this great and correct principle 
ever before you the successful treatment of typhus will 
be easy. But of the character of this sustenance we 
will enter more into detail. 

In the early stages of the fever, if the patient have 
appetite, he may be allowed almost any article of diet 
that his appetite seems to crave, avoiding, of course, such 
articles as would not be advised for a man not taking 
exercise, &c. As his dislike for food increases he will 
still consent to liquids and a few delicacies ; but soon 
there comes a time in every severe case of fever when 
everything but cold water is distasteful and when food 
has to be administered like so much medicine to the un- 
willing patient. At this time the digestive functions are 
in more or less complete abeyance, and the nutriment 
given must be such as requires the simplest process for its 
assimilation. Foremost among nutriments of this kind 
experience has put beef tea and broths, milk, eggs and 
alcoholic drinks. Whether alcohol is a nutriment or has 
any nutritious qualities or not it matters but little, we 
know that much of the alcohol taken into the stomach is 



190 THE FAMILY PHYSICIAN 

got rid of by the excretory organs or is retained for some 
time in the tissues after the manner of many medicines. 
But with food in its widest sense, as that which keeps up 
the vital functions, I do not hesitate to class alcohol. Who 
has not observed the common case of a steady drinker, 
maintaining for years a standard of bodily health upon 
a quantity of other nutriment wholly insufficient by itself 
to maintain such health. I once heard a regular drinker 
say that he could live well on raw turnips and whisky. 
To such a case a typhus patient offers some resemblance ; 
he may not be able to take enough food to maintain him, 
but alcoholic drinks will help him not to starve. There- 
fore alcohol must have a food value apart from its 
medicinal action, and in typhus is the place for that 
value to be exhibited. 

All the little tempting delicacies should here be offered, 
such as Gillen's meat juice, vermicelli in beef tea, 
chicken or veal broth, mutton broth with rice or bits of 
toast, egg in custards or beaten up with milk or wine, 
bread, jellies, blanc mange of isinglass or ground rice, 
wine whey, weak tea or coffee with milk. The palate 
should be tempted with those and many other dainties 
that a good nurse ought to be able to get up. They 
must be administered in small quantities and often. 
Two classes of patients must have alcoholic drinks — with 
either class they are indispensable — first, those who can 
not take a sufficient quantity of any other kind of 
nourishment; second, those who have in health been 
habituated to the use of strong drinks. Other cases in 
which alcohols must be used are, first, in the case of old 
persons ; second, in all cases of great prostration, in low 
delirium and coma ; third, when the pulse is very com- 
pressible or intermittent, and usually when it exceeds 
120 beats in a minute ; fourth, in cases where the extrem- 



AND GUIDE TO HEALTH. 191 

ities are cold and the surface is livid ; fifth, when there 
is much congestion of the lungs ; sixth, when there is 
any erysipelatous complications. 

In some cases of typhus alcohol is unnecessary and 
even inadmissible, for instance, when there is violent 
mechanical excitement at an early stage; also, with 
young people in whom, without notable depression, there 
is much bronchitis, or in whom true pneumonia can be 
diagnosed. Alcohol is rarely wanted before the eruption, 
and is most needful in the second or third week as the 
patient is approaching the crisis of his disease. For 
ordinary cases requiring alcohol, the strong wines are 
best adapted, such as Norton's Virginia Seedling, Sherry, 
Port, &c, while lighter wines with water form excellent 
drinks. Beer is a very good form of giving alcohol with 
other nourishing principles, and it is often craved for by 
the patient. Severe cases, particularly in old persons 
and in drunkards, require strong spirits, brandy or fine 
old rye whisky, mixed with beef tea, milk or eggs. A 
moderate allowance to an adult suffering under pretty 
severe typhus, with dry tongue, moderate delirium, of 
weak pulse of 120, is a bottle of Norton's Virginia Seed- 
ling or good Claret, or half a bottle of fine old Sherry 
daily. 

A bad case, with livid features, tremulous muscles, 
much low delirium, with, coma, weak pulse of 140, may 
have from twelve to twenty ounces of brandy or whisky 
daily, distributed in hourly doses. It often happens in 
such cases that patients for whom there might be a chance 
to obstinately clench their jaws against any nourish- 
ment, or are made sick by it; it is then sometimes 
possible to tide them over the time of crisis by frequent 
injections of beef tea and braiidy, which are always 



192 THE FAMILY PHYSICIAN 

well retained, even if there has been some tendency to 
diarrhea. 

For drinks, lemonade, soda water, cnrrant water, cold 
weak tea, without sugar or milk, or any of them, iced, 
may be allowed at the patient's choice. 

The above is the main line of treatment, but there are 
many symptoms and complications that can be met by 
medical agents. The thirst is best relieved by acidulous 
draughts — twenty drops of diluted hydrochloric acid in 
an ounce of water — the headache by cold water. The 
hair should be shaved or cut short, and the head placed 
in such a manner over a basin that a stream of cold water 
may be poured on it without saturating the clothes, or 
an oil silk bag or bladder of ice, beat fine, applied to it. 
Neither of these applications must be continued too long, 
for even cold water is a powerful depressing agent if too 
long applied. By this means the head can be relieved ; 
the cold produces a grateful sensation, and the patient 
is likely to sleep after the application. If. he does not, 
morphine may be given in quarter grain doses. This 
may be done in all cases except those in which the pupil 
of the eye is contracted very much. 

The bowels had best be kept open once a day, but 
slightly confined rather than purged. If there be diarrhea 
it may be checked by the use of the chalk mixture, as 
directed in diarrhea. If complicated with pneumonia, 
bicarbonate of ammonia and senega tea with simple 
syrup should be used. Vomiting is best checked by ice, 
lime water or soda water. 

During convalescence the patient may be allowed 
almost any article of diet that would be used in health, 
with beer, good Scotch ale or wine. I omitted to say 
that the body of the patient should be sponged daily in 
tepid water during the whole course of the disease. 



AND GUIDE TO HEALTH. 193 

Quinine has been recommended highly by some writers 
in this disease, but as there is no malaria or disposition 
to periodicity I can not see that it is indicated, and 
feel safe in depending upon the diet and alcohol for its 
treatment, and to safely conduct the patient through. In 
this course I am borne out by the finest physicians in 
Europe, and also in the United States. The heroic corps 
will hold up their hands in holy horror at it, but heed 
them not. Homoeopathy beats their treatment, as statis- 
tics show, and homoeopathy is only another name for 
nothing. 



13 



194 THE FAMILY PHYSICIAN 



TYPHOID FEYER. 

SYNONYMS I NERVOUS EEVEE — ABDOMINAL TYPHUS — CON- 
TINUED EEVEE — ENTEEIC FEVEE — PYTHOOENIC ENTEEO 
MESENTEEIC EEVEE — GASTEIC EEVEE — GASTEO BILIOUS 
EEVEE — MUCO ENTEEITIS. 



The a bove are only a few of the synonyms in use, lbnt 
enough, in all conscience, to confnse the minds of the 
common people. The appellation, " typhoid" " abdom- 
inal typhus," and the like, lead to an association of two 
diseases^ in the mind, which does not exist in reality ; 
such terms, therefore, lead to confusion. " G-astro" has 
reference to an organ which, at most, only functionally 
sympathizes with the principal lesion. The term " pytho- 
genic," introduced by Dr. Marchison to imply the putrid 
sores of the disease, is too general on the one hand, for 
other acute diseases may arise from this cause ; and, on 
the other hand, enteric fever may arise from other causes 
than putrid sewer emanations.. 

In a former article on inflammation {exudation) I have 
spoken at some length about the inconvenience and 
positive harm of using names for a thing that do not 
direct the mind to the thing or condition. I repeat, it is 
only calculated to create confusion. The rule holds 
good in everything — Agriculture, Mechanism, Astrono- 
my, Geology, Christianity, Law, or Medicine. 

In adopting a term to distinguish one thing from 



AND GUIDE TO HEALTH. 195 

another we should select one which at once marks it ont 
from all others, and points to a positive featnre by which 
it may "be readily distingnished from anything else 
whatever. This we can always do ; if one word will not 
express it we may nse more. The term entero-mesen- 
teeic is a brief definition of the disease, and the term 
onght to be used to the exclusion of all others to desig- 
nate this disease, which is a lesion of the solitary and 
agninated glands of the intestines. 

It may be described as a continued febrile condition 
of uncertain duration, accompanied by marked intestinal 
derangement. It commences with nausea or vomiting,, 
its progress is marked by profuse diarrhea of a dirty 
yellow appearance, associated with abdominal pain, 
tenderness and lymphoritic swelling ; and if the issue is 
unfavorable it terminates in exhaustion, internal hem- 
orrhage, or perforation of the bowel. Death usually 
occurs in the fourth week. During the height of the 
disease a scattered papular rash appears in successive 
crops on the abdomen and chest. As soon as the dis- 
ease is fully developed there is well marked hectic fever. 

JSTo disease presents, in the mode of the accession of 
the characteristic symptoms, in the gravity and sequence 
of these, and in its whole course and ending, so many 
variations, irregularities, complications and accidents as 
entero-mesenteric fever. 

SYMPTOMS. 

The disease may be considered in three classes — first, 
those in which the symptoms of gastro-intestinal irrita- 
tion remain latent for days, or even weeks, after the 
patient has declined in health ; second, those in which 
gastro-intestinal derangement is the chief feature of the 
disease from its outset to its termination; and third, 



196 THE FAMILY PHYSICIAN 

those which, in the suddenness of the invasion, the 
severity of the symptoms, and in the rapid course of the 
disease, closely resemble cases of narcotico-acid poison- 
ing. Many of the cases of entero-mesenteric fever "be- 
long to the first class. The disease, indeed, usually 
commences insidiously and without premonitory indica- 
tions of intestinal disorder. The decline of his health 
has "been so slowly progressive and uniform that the 
patient can not state precisely when his illness com- 
menced. For days or weeks he has lost appetite, and 
felt weak, languid, and disinclined for bodily or mental 
occupation, complaining of headache, chilly sensation, 
etc., etc. 

The second class is perhaps the most frequent. In 
these the nature of the disease is manifest in the begin- 
ning. The patient may have felt a little indisposed pre- 
viously, but he is in the midst of his usual occupations 
or on a journey when he is overtaken with headache, 
shivering and purging, followed by general pains and 
more or less fever ; there is complete absence of appe- 
tite, and nausea and vomiting are frequently amongst 
the earliest symptoms. There is pain in the abdomen 
and great thirst. In the third class of cases the symp- 
toms are so sudden and severe that there may be suspicion 
of poisoning by some acrid narcotic, such as colchicum 
or poisonous mushrooms. We find the patient in a state 
of high fever ; there is intense heat of the head, acute 
delirium, frequent vomiting and purging, the tongue dry 
and red, the abdomen tense and painful. The patient 
lapses into a state of stupor, the diarrhea persists, and 
he dies on the fifth or eighth day, or even earlier. 

To return to the first class — his weakness increases and 
we find the tongue moist and tolerably clean ; the skin 
cool, pallid and free from rash ; the pulse is rather small 



AND GUIDE TO HEALTH. 197 

and slightly accelerated ; the mind is clear and the ex- 
pression natural ; the bowels may "be regular or consti- 
pated; the abdomen is natural; the other functions. of 
the body are regularly performed. The disease, however, 
soon becomes manifest by its characteristic symptoms. 
Nausea and vomiting sometimes of a greenish fluid ; the 
skin hot and dry ; the pulse is increased in frequency ; 
the tongue is furred and usually presents red, prominent 
papillae at the margins and tip ; there is great restless- 
ness and increased headache ; the bowels become loose — 
two or three discharges a day ; the abdomen full. The 
symptoms of the first and second class here become 
the same. The tenderness in the abdomen is great, 
especially in the right side, and pressure upon this part 
produces a gurgling. A few round, rose-colored papules 
may now be seen about the abdomen, chest or back. 
Their number varies much and the quantity of rash 
bears no proportion to the severity of the disease. 
Usually we do not find more than three or four papules ; 
occasionally the chest and abdomen is closely spotted 
with them. During the prevalence of the diarrhea a few 
flesh spots appear every day, and after 48 hours the old 
ones begin to fade away. Diarrhea, frequently associated 
with bilious vomiting, now prevails, and the abdomen 
becomes distended and tympanitic ; the alvine discharges 
are watery and of light or dirty yellow color and putrid 
odor. "With the supervention of diarrhea all the symp- 
toms become greatly aggravated; the pulse ranges 
between 120 and 130 ; the skin is pungently hot and 
occasionally attains 107 to 108 ° . During this stage 
there is great irritability and often considerable delirium, 
especially at night. Symptoms of active pulmonary 
congestion: Accelerated breathing, pain in the chest, 
mucous rales and expectoration streaked with blood are 



198 THE FAMILY PHYSICIAN 

also liable to rise. The aspect of tlie patient is indica- 
tive of suffering, but the countenance is clear and the 
eyes bright as in scarlatina; the cheeks are suffused 
with a hectic flush ; the urine is clear and copious, and 
it is frequently retained. The patient may continue in 
this condition for several days, the body meantime un- 
dergoing rapid emaciation. The patient is unable to 
take food, the fever runs high, there is great restless- 
ness by day and broken sleep and delirium at night. 
Great pains are complained of in different parts of the 
trunk ; the breathing is quick ; there is some cough, and 
evidence of the presence of active congestion of the lungs. 
In many cases the tongue becomes dry, contracted and 
red ; the gums are liable to bleed ; sordes begin to form 
on the dry teeth. These symptoms may continue for a 
few days, the patient passing several watery, yellowish 
discharges each day from his bowels. Here is a turning 
point. If the patient has escaped the danger of hemor- 
rhage and perforation of the bowels he may, at the end 
of this time, begin to progress towards recovery, but if 
the symptoms take an unfavorable turn he will almost 
surely die. 

If we can subdue the gastric irritation and keep food 
in the stomach and restrain the diarrhea, the symptoms 
will usually take a favorable turn. 

The cause of entero-mesenteric fever is not well settled. 
It seems to be pretty well established that water that has 
been saturated with the drainage of cess-pools and other 
filthy matter will produce the disease. The question of 
contagion is an open one ; and while some statistics go far 
to prove that it is contagious, very clever writers seem to 
think differently ; but that it prevails as an epidemic none 
will deny. That it always takes On, in malarial districts, 
an intermittent or a remittent type — most always the 



AND GUIDE TO HEALTH. 199 

latter — none will deny, and, in fact, that malaria lias not 
got much to do with its production, I am not quite cer- 
tain. As a general thing, no doubt, its production is 
much owing to the same cause that produces typhus. If 
the question be asked why that cause will produce 
typhus in one and entero-mesenteric in another indi- 
vidual, I will answer by asking why malaria will pro- 
duce dysentery in one individual, intermittent in another 
and remittent fever in a third ? The fact that entero- 
mesenteric takes on an intermittent or a remittent type 
in a malarial district is not evidence conclusive that 
malaria has anything to do in its production, for persons 
long exposed to malaria will always exhibit a tendency in 
all diseases to periodicity ; this is a fact too well known 
among medical men to need proof. But while it furnishes 
no evidence that malaria has anything to do in its pro- 
duction, it is a very strong intimation that all such 
patients should be treated with quinine in connection 
with the other remedies ; and this important fact must 
never be lost sight of by the practitioner. 

TKEATMENT. 

Men talk and write fluently about " breaking up " 
typhoid or entero-mesenteric fever, and tell us the pro- 
cess by which it is done, disagreeing, however, widely 
on the latter — the how. 

Even as fine a physician and clever a writer as Dr. 
John Hughs Bennett, of Scotland, speaks in this way in 
answer to the question of Can we cut short a continued 
fever (meaning an entero-mesenteric) ? He says : " There 
can be little doubt that it is of immense importance to 
cut short the disease, if possible." To this I most 
heartily agree. He proceeds : " Without speaking too 
positively, I have been induced to believe in this possi- 



200 THE FAMILY PHYSICIAN 

lbility, under certain circumstances, by means of eme- 
tics. A fortnight after being appointed physician to the 
fever hospital of this city, in 1844, I experienced lassi- 
tude, headache, and that peculiar cold feeling in the 
back which generally ushers in fever. I took an emetic 
of antimony and ipecacuanha, and on the following day 
was well. Three weeks afterwards I experienced the 
same symptoms, but thinking it possible that, after all, 
the emetic had not really been the cause of their re- 
moval, I allowed the disorder to proceed, which termi- 
nated in a prolonged relapsing fever, with three distinct 
relapses. I think I have observed the same in other 
cases; and now, as a rule, whenever called in at the 
early period of fever, I always order an emetic. This 
practice, so far as I have observed, never does harm, 
often good ; and although the point is, of course, impos- 
sible to demonstrate, it has, I think, been successful in 
checking at the onset many cases of fever." 

The evidence upon which the doctor bases his belief 
in this " possibility " you can not fail to have seen is 
barely presumptive. He felt badly and took an emetic 
and got well. There may not have been the slightest 
connection between this lassitude and headache and the 
fever he took three weeks afterwards, and even if there 
was, is there any evidence or have we any right to be- 
lieve that an emetic would have cured him of this second 
attack. There is no weight whatever to be given to this 
circumstance. But he says it has been his rule ever 
since to order an emetic, which never does harm, often ^ 
good, and he thinks it has been successful in checking 
many cases of fever. 

Now, Dr. Dundas contended that he could cut short 
an attack of typhoid by the administration of quinine 
in ten grain doses, for five or six times, two hours apart. 



AND aUIDE TO HEALTH. 201 

This statement of Dr. Dundas, of Liverpool, supported 
"by the statements of other medical men in Liverpool, 
Dr. Bennett was induced to try, which he did honestly 
and persistently in quite a large numlber of cases (seven) 
during the winter of 1S51-2, and he says it did not in 
any way shorten the disease. Dr. Christison tried it in 
one case and Dr. Robertson in eight, making in all six- 
teen cases in which it had been tried " with," says Dr. 
Bennett, "uniform failure in all." 

Dr. Bennett admits that Dr. Dundas may have and 
did give quinine to patients who had the symptoms or an 
attack of the mild form of fever, febicula, and adds that 
it is impossible to tell what the character of the fever 
will be earlier than the seventh day ; and, therefore, for 
Dr. Dundas to make a fair trial with quinine he should 
not commence it until after the seventh day. Now, sup- 
pose we apply the same rule to Dr. Bennett with his 
emetics, would he " believe in the possibility " of their 
cutting short the disease then ? Certainly not ; he is too 
good a physician for that. No, Dr. Dundas' quinine fails 
to cut short the disease, Dr. Bennett's " emetics " will fail, 
and Drs. A. & B.'s mercury, pushed even to salivation, 
will always fail as much to cut short entero-mesenteric, 
or typhus fever, or inflammation (exudation), as they 
will to cut short a case of small-pox or measles. And 
the sooner every one learns this the better it will be for 
all hands. As long as men destroy the vital forces by 
trying to cut short a disease that has a certain course to 
run, and one that requires all the strength of the system 
to run it, just that long will from twenty -five to thirty- 
three per cent, of the patients die that are treated for 
pneumonia and typhoid fever. But when they are 
treated with diet alone the mortality is reduced fifty per 
cent. , as statistics show, and by the use of proper medi- 



202 THE FAMILY PHYSICIAN 

cation, aiding, sustaining and assisting nature, and prop- 
erly combating and relieving the dangerous symptoms 
as they arise, the mortality will he again largely reduced 
and much suffering saved those who recover. To do this 
is now the proper study and the legitimate sphere of the 
physician. With this principle well before us we can 
not materially err in the treatment of even so formidable 
a disease as entero-mesenteric fever. 

During the first stage or the stage of excitement, and 
while the fever symptoms are high, give the following : 
Dissolve six grains of antimony (tartar emetic) in half an 
ounce of warm water, add to it two ounces of liquor 
acetate of ammonia and five and a half ounces of water ; 
give one tablespoonful every four hours. Should it be 
necessary to move the bowels, castor or sweet oil to a 
dose of which five drops of laudanum has been added 
must be given. Cold must be applied to the head, as 
recommended in typhus, by cutting short the hair and 
applying the ice bag or the stream, placing the head 
over a basin. 

There is the same necessity for diet in this that there 
is in typhus, and the same rules of feeding must be 
observed. The wine need not be commenced as early in 
this as in typhus ; it must be promptly given as soon as 
the pulse begins to be weak, which sometimes is early in 
the disease. For this disease I would recommend the 
Norton's Virginia Seedling in preference to any other. 
Amongst all the agents at our command there is none 
which will enable us to conduct a case of fever to a 
favorable termination more successfully than stimulants, 
when properly managed. 

If the disease presents an intermittent or remittent 
type, quinine must be given in from five to ten grain 



AND GUIDE TO HEALTH. 203 

doses during the remission every two hours, until a ring- 
ing in the ear is produced. 

The diarrhea must be checked — at least so there is not 
more than one or two discharges a day — by the use of the 
chalk mixture. To four ounces of chalk mixture add 
one or two drachms of laudanum, and give it in table- 
spoonful doses. 

If the abdomen becomes swelled, a thin linen bandage 
should be applied around it, and wet cloths may be 
placed under it ; if it becomes much swollen and 
tender a few drops of turpentine may be dropped upon 
a cloth wrung out of warm water and applied to it under 
the bandage, and the patient should take the compound 
soap pill, to two grains of which one fourth of a grain of 
nitrate of silver has been added. One of these pills 
should be taken every four hours. During convalescence 
great care must be taken as there is always a very great 
tendency to relapse in this disease, so much so that some 
authors have termed it "relapsing fever." There is 
always danger of relapsing until the stools become in 
every way natural, hence care and a proper diet must be 
enjoined on the patient for weeks. 



204 THE FAMILY PHYSICIAN 



YELLOW FEVER-BLACK YOMIT. 



This is an infections, continued fever, nshered in with 
langnor, chilliness, pain in the lumbar region and frontal 
headache. 

From the year 1647, when the first recorded outbreak 
of yellow fever in the West Indies (according to Ligon's 
history of Barbadoes) occurred, to the present time this 
disease has been recurring at irregular intervals in the 
epidemic form, and gradually extending its range. " It 
has, moreover," says Dr. John Denis McDonald, " ap- 
peared, in many instances, to borrow new vigor by its 
importation from one place to another." It may be said 
now to be endemic at the islands of St. Thomas and St. 
Domingo. Still there is no proof of its spontaneous 
development anywhere. 

The symptoms of yellow fever manifestly result from 
the more or less potent operation of some subtle organic 
poison upon the system through the medium of the 
blood. 

Whatever physical condition — such as increase of 
temperature, moisture and subsequent evaporation, and 
the like — may be favorable to, or merely coincident with, 
the development of yellow fever on shore, when once 
communicated to a ship and isolated by removal from 
all local influences, its phenomena are very striking and 
suggestive. Under such circumstances it is difficult to 
witness the spread of the disease from one individual to 



AND GUIDE TO HEALTH. 205 

another, and its virulence becoming more intensified by 
the unavoidable crowding of the sick, without recog- 
nizing the important part which the emanations and 
the excretions of the human body itself must take in the 
matter. 

We are in want of proof of the spontaneous develop- 
ment of yellow fever independently of infected places or 
persons. The periodical appearance of yellow fever, 
with intervals of immunity, has its parallel in a fact well 
known to the students of the diatomacse and dermidiacse, 
namely, that particular species which are known to exist 
in a definite pond or pool for one season may be at 
another replaced by forms never before detected in the 
same spot ; while again the original species, under favor- 
able and often unaccountable circumstances, reappear 
after the lapse of a certain time. 

It is not our intention to make even brief reference to 
all the views that have been put forward as to the nature 
of the specific cause of yellow fever. The infectious 
nature of yellow fever is now not only generally admitted, 
but it forms one of the most distinctive features of the 
disease, at once marking it off from those fevers which 
in nearly every other particular simulate it. It is scarcely 
necessary to multiply or repeat the strong proofs brought 
before the Epidemiological Society of London, in the 
papers of Dr. Brison, and the important support of the 
late lamented Dr. McWilliam. The tenets of the writer, 
derived from actual facts, are the following, acknowledg- 
ing a genealogy to the widely spread family of yellow 
fever : 

First, That the first place or the first person, or both, 
must have become infected somewhere or somehow. 

Second, That by veritable, but unknown, or rather 



206 THE FAMILY PHYSICIAN 

untraced links with this source places having "become 
infected may infect persons. 

Third, That persons infected may infect other persons 
and places previously presumed to he healthy. 

Fourth, That the clothing of infected persons or of 
healthy persons, having communicated with infected 
places or persons, may impart infection to other places 
or persons. 

Fifth, That if places were moveable, like persons 
(which is literally true of ships), on being infected, they 
would impart the virus to other places in sufficiently 
close proximity. 

Sixth, Finally, from the investigation of the history of 
particular cases, it has been satisfactorily shown that 
the period of incubation or latency in this disease, i. e., 
from the imbibition of the poison to the first appearance 
of symptoms, ranges from one to fourteen or fifteen days. 

Like cholera, yellow fever may in the course of a few 
years range over the whole world ; its spread grows wider 
and wider every few years, and the inhabitants of the 
New England States may be struck with terror and 
dismay by witnessing its destructive ravages among 
them. The temperature of 72 ° is assumed to be essen- 
tial to its development, though cases exceptional to this 
rule have happened. It was once thought that a tempera- 
ture even higher than this was necessary for cholera to 
develop and continue, but now we know that it has pre- 
vailed with unabating fury in cold countries, even in the 
dead of winter, when the thermometer ranged as low as 
13° Fahr. Taking this view of the case the subject 
becomes one of interest to every one. 

SYMPTOMS. 

The disease is generally ushered in by chills, alterna- 
ting with flashes of heat, sometimes preceded by loss of 



AND GUIDE TO HEALTH. 207 

appetite, costiveness, flatulence, a sense of debility, and 
the eyes humid and bright. These premonitory symptoms 
are not always present. The flashes of heat gradually 
settle down into regular fever, which is often observed to 
become more severe towards evening, with something 
approaching a remission in the morning. The amount 
of fever, moreover, bears relation to the amount of chill 
preceding it. Frontal headache is also an early symptom, 
with shooting pain through the orbits and temples ; but 
distressing as these may be they are usually trivial in 
comparison with the agony of the lumbar pains which 
frequently seize the patient at this period and " fell him 
to the ground," says Dr. McDonald, " in a writhing and 
convulsive state." In some severe cases, however, this 
symptom is nearly entirely absent. From the very com- 
mencement the patient may be troubled with nausea and 
epigastric tenderness, or they may be developed as the 
reactive stage advances. 

There is not much uniformity in pulses ; they range 
from 90" to 120 in a minute. The tongue exhibits a 
creamy, white coat on the dorsum, with red tip and 
edges, and injected papillae, with or without soreness of 
the throat. As the second stage advances, irritability of 
the stomach is added to the nausea, and the epigastric 
pain and tenderness become more distressing. The 
patient craves for cold drinks, which are immediately 
rejected, first with some retching and pain, but subse- 
quently without effort. The matters vomited usually 
have a suspicious appearance ; thus they are sometimes 
imbued with bile, slightly streaked with blood, or quite 
serous with small chocolate colored flocculi, discovering 
a tendency to hsemorrhagia oozing from the lining of the 
stomach. The urine is scanty and high colored, the 
stools become gradually more and more deficient of bile, 



208 THE FAMILY PHYSICIAN 

and the bowels are often obstinately constipated. The 
patient begins to be vigilant and restless, and disposed 
to leave his bed, go into another, or walk about naked 
if he is permitted. He exhibits an evident derangement 
of intellect, thongh he may answer questions coherently. 
Sometimes he has wild hallucinations and other symp- 
toms similar to those of delirium tremens. Febrile 
reaction, or, in other words, fever, may continue for an 
indefinite period between a few hours and two or three 
days, and its duration is said to be in the inverse ratio 
of the violence of the attack. When it subsides it is 
never more to return, or seldom, at least, being a disease 
of one single paroxysm. It is followed by a state of 
remission or metastasis. On this remission, should all 
the symptoms be alleviated, the pulse becoming less 
frequent, or even normal, the delirium subsiding, and, 
above all, if there be no more irritability of the stomach, 
active perspiration or a critical discharge of bile from 
the bowels may place him on the high road to recovery. 
Should the skin have assumed its yellow tint, it will 
remain all through the convalescence. 

If, on the other hand, the ferrety eye whitens, the 
cheek grows pale, and the lips are blanched white, the 
pulse is weak and compressible, and the delirium is 
persistent, with irritable stomach, the apparent remission 
is delusive and a fatal issue is pending. 

TKEATMENT. 

Whatever is done in yellow fever should be done 
quickly. We have it on the authority of physicians of 
large experience, that the disease has been cut short by 
the timely administration of remedies that have been 
tried and found wanting at a later period. The first 
thing at the commencement of an attack of yellow fever 



AND GUIDE TO HEALTH. 209 

should be a tepid alkaline bath, after which the feet is 
to be placed in water as warm as it can be endured by 
the patient. Then he should take a purgative dose, con- 
sisting of ten grains of calomel, ten grains of jalap, and 
three grains of ginger ; and in six hours, if the medicine 
has not operated, an injection of castor oil, molasses and 
warm water should be given, and repeated at intervals 
until an action is had, after which opium in full doses 
should be exhibited, keeping the patient under its 
influence. I know it is contended by some that opium 
in any form is not admissible in this disease ; so it was 
contended a few years ago of puerperal convulsions, but 
we know now that opium is the very best remedy in that 
complaint 

The poison that produces yellow fever seems to be of 
an intoxicating character, but while it intoxicates it pro- 
duces excruciating pain, both in the head, lumbar and 
epigastric regions. It produces this intoxication on a 
different principle to that of acohol or opium ; the excite- 
ment given to the nerves is of a painful character ; the 
soothing, anodyne effects of opium are much needed, and 
in cases where there is not much vascular excitement 
even brandy toddy is indicated. 

I look upon opium as all important in the treatment 
of yellow fever ; not, however, in the light of a specific 
like quinine is in malarial fevers, but as an article to 
palliate the symptoms, and the symptoms in yellow fever 
are the disease. 

While opium is being given other things should not 

be lost sight of; foot baths should be repeated half a 

dozen times a day, the body should be sponged often 

with alkaline water, cold or warm, as agreeable to the 

patient. The bowels should be kept open by the use of 

injections, and good beef tea and brandy should be given 
14 



210 THE FAMILY PHYSICIAN 

the patient by injections freely. While all this is being 
done he should use lime water in such quantities as 
seem to agree best with his stomach. Five grain doses 
of chlorate of potash should be given him every hour or 
two dissolved in an ounce of water. 

If the patient has been exposed in a malarial district 
and his fever exhibits a periodicity in its character, qui- 
nine may be used in fifteen grain doses, administered by 
injection. But this is not a malarial disease, and as a 
general thing quinine will do no good, if, in fact, it does 
not prove injurious by producing depression. 

As the disease advances the system must be sustained. 
When beef tea can be retained in the stomach it must be 
freely given, in connection with good brandy. But, I 
repeat, they must be given often by injection; without 
this there can be but little hope of saving the life of the 
patient. This is a fundamental principle in the treat- 
ment of yellow fever ; the whole tendency of the patient 
is to sink, and unless he is carefully sustained the pow- 
ers of life will succumb. 

There is no " specific" found as yet for yellow fever ; 
we have to treat it on general principles, our great object 
being to obviate the tendency to death and sustain the 
vital power in its struggle with the foe. Dr. McDonald 
tells us that the ward-room cook of H. M. S. Jearus 
" had very nearly succumbed at this crisis, but he rallied 
immediately on the administration of a stoat glass of 
rum and water and recovered steadily." 

I want to repeat that the fears of using opium in yellow 
fever are groundless, and that it is an essential in the 
treatment of that complaint. And if yellow fever was 
treated with opium alone, in connection with plenty of 
beef tea and brandy per rectum, and lime water per 



AND GUIDE TO HEALTH. 211 

month, the mortality wonld not Ibe great. But while 
these things are "being done much good is also derived 
from pedilumum and the tepid or cold alkaline bath for 
the body. The chlorate of potash will also take a high 
stand as a remedy in connection with the means above 
named in the treatment of yellow fever. 



212 THE FAMILY PHYSICIAN 



DTSEITEEY. 



This disease consists in an inflammation of the mucous 
lining memlbrane of the lower or larger intestines, and is 
divided into two forms, acute and chronic. There is a 
material difference between dysentery and diarrhea, as 
will he seen Tby the description of the two. 

Causes. — Dysentery has been ascribed to wet and 
cold, to contagion, to malaria, polluted water, bad or salt 
food, to detention in crowded barracks and transport 
ships, to insufficient clothing and bedding, to retained 
excretion or to drastic purgations. During the great 
war through which we have just passed hundreds and 
thousands of soldiers on both sides fell victims to this 
scourge. Intermittent or remittent fevers and dysentery 
often co-exist or succeed each other in the same individal. 
In this climate dysentery sometimes prevails in an epi- 
demic form during the latter part of summer when the 
days are hot and the nights cool, particularly if there has 
been much rain or damp weather. 

SYMPTOMS. 

Acute dysentery may present itself without any pre- 
vious constitutional disturbance ; but generally at the 
commencement there is uneasiness and pain in the 
abdomen of a griping character, with a frequent desire 
to go to stool, which is followed by temporary relief. 
The evacuations become thin, mucous and bloody, and 



AND GUIDE TO HEALTH. 213 

are frequently mixed with small, hard, separate lumps of 
feces. TTlien the disease becomes developed and ulcer- 
ation or sloughing commences, the desire to go to stool 
is more frequent and the ease which succeeds is more 
transient; the scanty evacuations produce distress rather 
than relief; the patient is constantly tormented with 
griping ; the stools become foetid, dark-colored and 
mixed with streaks of blood and lymph, and the bladder 
sympathizes with the rectum, causing a frequent desire 
to void the urine. In all cases there is more or less 
fever and constitutional disturbance : the tongue is furred; 
the pulse quick and small ; the skin harsh, hot and dry ; 
thirst urgent, with no appetite ; difficulty of breathing, 
and great prostration. When the disease becomes 
chronic it is most intractable ; there is usually diminu- 
tion of the mucous membrane, with degeneration of the 
glands, while the patient wastes away ; the skin becomes 
dry and scaly ; there is improvement one day with a 
relapse the next ; the tongue is florid and glazed ; the 
discharges are most offensive, and the pain, &c, exhausts 
the patient so that death is looked forward to as a 
welcome source of relief. Dysentery is often called 
"bloody flux." 

TEEATMENT. 

The treatment of dysentery may be commenced by the 
administration of a full dose of citratized magnesia, to 
which half a grain of sulphate of morphine has been 
added. Slippery elm bark tea or other good demulcent 
drinks must be used from the very commencement of the 
disease, one of the objects being to soothe the inflamed 
membrane. As soon as the cathartic operates (and if it 
does not operate in four or five hours it should be re- 
peated without the morphine) give then one grain of 
opium and about three of ipecac, or as much ipecac as 



214 THE FAMILY PHYSICIAN 

the patient will bear without nauseating th'e stomach, 
and a patient with dysentery or " flux " can bear almost 
incredible quantities. I have great faith in opium and 
ipecac in this disease. Opium is objected to by some 
because it checks the secretions ; but in combination 
with large doses of ipecac this objection is done away 
with. Opium gives the patient ease and diminishes the 
peristaltic motion of the bowels, and these are the two 
grand objects in the treatment of this disease. Give the 
powder of opium and ipecac about every three, four or 
six hours, as the case may seem to require. If this treat- 
ment produce constipation recourse must be had to castor 
oil or sweet oil. Great relief may be had by folding a 
wet cloth three or four double and laying it on the 
abdomen, or by fomentations or warm poultices on the 
bowels. When the dysenteric inflammation has reached 
an advanced stage, when there is disorganization of 
tissue, then there are still two points to be aimed at, viz. : 
to support the general strength while the diseased struc- 
tures are to be kept as quiet as possible. Under these 
circumstances tonics, astringents and opiates are the 
tools with which to work. Tincture of Peruvian bark 
and tincture of Colombo, equal parts, may be used in from 
one to two teaspoonful doses three or four times a day, 
or quinine will answer a good purpose in one grain doses 
four or five times a day. When the dejections are abun- 
dant, gum kino and laudanum are the remedies, in chalk 
mixture. Take chalk mixture three ounces, tincture of 
opii (landanum) half an ounce, gum kino thirty grains ; 
let the kino be rubbed well in a mortar with the chalk 
mixture, and give one tablespoonful as often as seems 
necessary to check the violent symptoms. An injection 
of slippery elm bark tea two ounces and laudanum one 
teaspoonful is an excellent remedy in this form of disease. 



AND GUIDE TO HEALTH. 215 

The diet ought to be generous ; milk, raw eggs, animal 
food, ripe Concord or other good varieties of table grapes 
should be allowed. Stimulants may be, and often are, 
necessary ; nothing will answer a better purpose than 
the pure Norton's Virginia Seedling wine, not the sugar 
and water " two measures to one " wine of commerce, but 
the pure juice of the grape. There are other good varie- 
ties of our native wines, but I am not sufficiently 
acquainted with their medical properties to speak of them 
or recommend them in disease. No doubt the time is 
not far distant when they will take the place in the sick 
room of all the brandies and foreign wines that we have 
to use now, made up, many of them, of chemicals of a 
pernicious character. An unfortunate movement has 
been made in the manufacture of our native wines in this 
State, mixing with the juice large quantities of water 
and sugar. It will be years before confidence is re- 
established in our native wines — it will be a long time 
before they recover from the blow. The medical profes- 
sion would not like to recommend to a patient in a criti- 
cal condition impure wines, and if the wine growers of 
Missouri expect to have their wines introduced into the 
sick chamber or recommended by intelligent physicians, 
they must frown down every such cheat as that per- 
petrated by mixing two measures of water to one of the 
grape juice. 

In chronic dysentery, if the patient can it is best to 
seek some mild, dry, equable climate. Morphine is, per- 
haps, his best remedy, or at least affords him more 
relief than any other. Great care must be taken in diet. 
Sydenham, in his practice of two centuries ago, treated 
dysentery simply with chicken tea, and did it with vastly 
greater success than it is treated now by a certain school 
of practitioners who treat it with mercury, sugar of lead, 
opium and alum, blood letting, leeches, &c. 



216 THE FAMILY PHYSICIAN 



DIARRHEA. 



Diarrhea is the name given to all cases where there is 
looseness of the bowels, in which the alvine evacuations 
are frequent and liquid, without any inflammation of the 
intestines. 

The most common cause of this complaint is, over 
eating or using improper food, or drinking foul water ; 
it is often the case that a change of water will induce 
diarrhea. There are many other causes for the complaint, 
such as exhaustion consequent upon starvation, inhaling 
the fumes from decayed animal or vegetable matter, or 
exposure to damp, cold, or very great heat ; it is often a 
symptom of some other disease. 

SYMPTOMS. 

Purging, nausea, furred tongue, foul breath, flatulence., 
griping pains and acid eructations, with unhealthy, 
watery stools, are some of the symptoms that usher in 
an attack of diarrhea. 

This can not be considered a very dangerous complaint 
except in children or very old people. 

TREATMENT. 

This must depend very much upon the cause of the 
complaint. If it arise from fecal matter in the bowels 
it must be removed, and for this purpose one or two 
ounces of castor oil with fifteen drops of laudanum 



AND GUIDE TO HEALTH. 217 

must be given. After proper action is had upon the 
bowels, the chalk mixture three ounces, laudanum two 
drachms, gum kino half a drachm, brandy one ounce ; 
rub the kino in a mortar with the brandy until it is dis- 
solved, then add all together and give one tablespoonful 
every two hours until relief — care being taken to move 
the bowels if they become costive, i 

The diet and general habits must be properly attended 
to. Beef tea is an excellent article with light bread or 
crackers crumbled into it. The patient must avoid great 
exercise. 



218 THE FAMILY PHYSICIAN 



CHOLERA MORBUS. 



This is a disease common in warm seasons, and espe- 
cially in warm climates. The principal features of the 
disease are, vomiting, purging and severe griping pains 
in the abdomen. 

CAUSES. 

Sudden transition from heat to cold, suppressed perspi- 
ration, rancid food or that which is indigestible, cold, 
watery fruit, such as cucumbers, or any indigestible 
food acting on a stomach previously weakened by heat 
or fatigue. 

SYMPTOMS. 

The first symptoms of cholera morbus are, flatulence, 
sour belchings, with pain of the stomach and intestines. 
These are quickly succeeded by nausea, violent vomit- 
ings, purging of bilious or feculent matter, frequent, 
small, irregular pulse, great thirst at first, heat, but 
quickly succeeded by cold, clammy sweats, spasm and 
coldness of the extremities, flacidity of the skin, hiccup, 
and sometimes death in a few hours. 

In the more malignant forms of the disease it is not 
uncommon for the discharge to resemble the " rice-water 
evacuations of Asiatic cholera." Still writers keep up a 
distinction between the two diseases. 

TREATMENT. 

* A large mustard plaster should be placed over the 
stomach and allowed to thoroughly redden the skin. 



AND GUIDE TO HEALTH. 219 

Twenty-five drops of laudanum may Ibe given the patient 
just after a paroxysm of vomiting and purging. These 
spells of vomiting generally occur about every fifteen or 
twenty minutes ; and if the laudanum is given just 
before one of them it will, of course, be ejected ; if given 
immediately after one it will most likely be retained ; 
and often the first dose will stop the vomiting and purg- 
ing. Morphine, on account of the small bulk, in some 
cases may be preferable; if it is given, from a third to a 
half grain may be administered at the first dose and 
repeated in a dose of one fourth of a grain in two hours ; 
if the first dose has been vomited up another at once 
must be given. The chalk mixture, as prepared and 
recommended for diarrhea, may be used in this com- 
plaint, but must be repeated often. Brandy mint julep 
will be found of great advantage in connection with the 
other treatment recommended. When the patient begins 
to exhibit signs of weakness, stimulants and beef tea 
must be promptly given, and if they are not retained in 
the stomach they must be given by injection. Bad cases 
may be treated as recommended for cholera. For the 
relief of the spasm (cramps), which is sometimes a 
very troublesome symptom, the bromide of potassium 
may be used in doses of from five to ten grains, in pills 
or solution. This is also the best treatment for the 
cramps in cholera. 



220 THE FAMILY PHYSICIAN 



EPIDEMIC CHOLERA. 

SYNONYMS : ASIATIC CHOLEEA — ALGIDE CHOLEEA — BLUE 
CHOLEEA — CHOLEEA MOEBUS — ASPHYXIA — CHOLEEA 
SPASMODICA — MALIGNANT CHOLEEA — PLAGUE. 



Cholera is an epidemic, and in some places an endemic, 
disease of great mortality. It is characterized in its- 
developed stages "by vomiting and pnrging of watery 
fluid ; by rapidly cansing a state of the body called col- 
lapse, in which there is extreme depression or diminution 
of nearly all the functions of life ; by terminating in 
death, often within twenty-fonr honrs from the first 
symptoms of the disease, or in healthy reaction, or in 
varions dangerons sequels, mostly of a typhns character. 
It is a severe epidemic affection, well known in India, 
Africa, Enrope and America. In Calcntta and Bombay 
it prevails so constantly that it may now be said to be 
endemic there. 

The disease is one that has become so wide spread, 
visiting almost every country on the globe, and is so 
terrible in its character, carrying dismay and destruction 
wherever it goes, that a careful examination of it, in all 
its different aspects, beginning with the first of its known 
history, symptoms and treatment, seems to be due to 
the people. In fact, a conviction has seized the minds 
of the people that the Doctors know but little of the 
cause, and nature, and treatment of cholera. Such, how- 



AND GUIDE TO HEALTH. 221 

ever, is not the case ; the disease has been well studied 
and its records well preserved, the most important of 
which I have before me and will give to the public. 

There is but little room for doubt that our forefathers 
were acquainted with cholera in Europe. In India 
cholera has been observed several times since the Eng- 
lish have had possessions there. There is evidence of 
its having been known in Madras in 1769, 1770, and 1774. 
In fact, Sydenham, in his description of cholera morbus 
in 1669, vol. i, page 219 — " heartburn, thirst, quick pulse, 
heat and anxiety, and frequently a small irregular pulse, 
great nausea, and sometimes colloquative sweats, con- 
traction of the limbs, fainting, coldness of the extremities, 
and other like symptoms which greatly terrify the 
attendants, and often destroy the patient in twenty-four 
hours." He also says : " There is likewise a dry cholera, 
with retchings or stools, which I never saw but once, 
and that was at the beginning of the present autumn 
(1669), when the former kind was very common." Dr. 
George Wallas, in his notes in Sydenham's Practice, 
which was published in 1788, speaking of the treatment 
of cholera morbus, says "It is also mentioned, according 
to Sauvages, by Galen, cholera, by Revisius, cholera, and 
by Hippocrates, dry cholera." Nosologia Methodica, vol. 
n, page 352. He, Wallas, says : " This mode of cure 
has been long adopted, and in the genuine cholera estab- 
lished by successful experience. Dr. Charles Ayrton 
Douglas first orders plentiful dilutation with warm 
water," &c, showing conclusively that, long before its 
appearance in Madras, it had been treated on a plan 
that we may term dilutation, which we may speak more 
particularly of in the future. 

The first authentic history we have of cholera is in the 
delta of the Ganges, in spots where the huts are on the 



222 THE FAMILY PHYSICIAN 

mounds, surrounded with pits which are the receptacles 
of dejections, and of this stagnant water the natives drink. 
After appearing in Madras in 1769, 1770, and 1774, it 
attacked Col. Pearse's command while marching to join 
Sir Eyre Coote, in 1781, and Col. Cockerell's com- 
mand in 1790. It then appeared in three or four 
different places in India in 1800. Independent, how- 
ever, of old records, we have a prominent starting point 
for the history of cholera in 1817, since which time it 
has been frequently prevalent. In 1818 the western world 
was startled with the intelligence of the appearance in 
India of a disease which was ravaging lower Bengal, and 
had also attacked the camp of the Marquis of Hastings, 
then engaged in the Mahratta war, and who was at that 
time halted on the banks of the Sind, in the upper pro- 
vinces. A new disease, or at least one unknown in such 
a terrific form, was carrying destruction through all the 
ranks of the army, both European and native. The 
scourge appeared in Lord Hastings' camp on the 6th 
November, 1817, and in five days destroyed 5,000 men. 
In it, in all, 9,000 deaths occurred. 

But not in the camp of war only did it cause surprise 
and terror. After having shown itself during the previ- 
ous months in Mymunsing, Patna, Kishnaghur, Chitta- 
gong, and some other places, it burst out in August, 1818, 
in the agricultural province of Jepore, amongst the 
peasants and laborers of the rice swamps and palm 
groves. Many thousands were swept away by the pes- 
tilence in a few weeks. 

There might have been such a disease in the mist of 
past ages — it may have been the disease so frequently in 
old times called the " plague," but, as we have to de- 
pend upon symptoms to define diseases, we can never 
determine. But certain it is that the memory of living 



AND GUIDE TO HEALTH. 223 

man possesses no vivid or substantial knowledge of it. 
It burst upon the suffering generation with the violence 
of an unheard of plague, impressing all with dread and 
consternation. 

From this starting point in India cholera spread East 
and West, far beyond the bounds of Hindostan. Its 
appearance in other lands may be traced with tolerable 
accuracy. From Bengal it spread eastward and south- 
ward in the following chronological order. We find it in 
1818, in Burmah, Arracan and Malacca; in 1819, in 
Perang, Sumatra, Siam and Ceylon ; in 1820, in Tonquin 
China, and China ; 1822-23-24, in all China. Turning 
to the West we find it in July, 1821, at Muscat and the 
Persian Gulf ; in 1822 in Persia, until 1830 ; and in 1823, 
at Astrachan, without spreading further westward until 
1829, when it reached Orenburg, through Tartary, 
revisited Astrachan in 1830, and from thence started on 
its course through Europe. The westward course con- 
tinued slowly. In May, 1831, it was severe at Moscow 
and Warsaw ; in July of the same year, at St. Peters- 
burg and Constadt ; in October, at Berlin and Vienna. 
In England the first cases showed themselves at Sunder- 
land, in October, 1831, and the epidemic prevailed in the 
British Empire for fourteen months. It crossed the 
Atlantic and reached Quebec in 1832. This fatal malady 
ravaged the whole of Europe, and left that quarter of 
the globe in 1837, the last place affected being Rome. 
Since 1817 epidemics of cholera have been frequent all 
over India, so that the disease may be said to have been 
naturalized there, causing a large mortality among 
all classes. Besides the first great epidemic above 
mentioned, the western parts of the world have suf- 
fered from three severe visitations of cholera, viz. : in 
1848-49-50 ; in 1853-54-55, and in 1864-65-66. Then it 



224 THE FAMILY PHYSICIAN 

appeared to have traveled from tlie East much in the 
manner as that in 1832. Thns cholera seems to have 
traveled East, South, "West and North from Bengal, 
which became hut the centre of an epidemic that has 
comprised nearly all the world. It traveled slowly at 
first, and not continuously, Ibut in irregular waves ; 
checked sometimes, hut not destroyed by winter cold. 
Neither climate, nor season, nor earth, nor ocean seem 
to have arrested its course or to have altered its features. 
It was equally destructive at St. Petersburg and Moscow 
as it was in India ; as fierce and irresistible amongst the 
snows of Russia as in the sunburnt region of India ; as 
destructive in the vapory districts of Burmah as in the 
parched provinces of Hindostam 

OAUSE. 

In considering the causation of cholera we must bear 
in mind that we have to account for a disease spreading 
quickly over large areas, often preceded by epidemic 
diarrhea, frequently developing itself with little warning 
in the places attacked, and often disappearing suddenly 
and returning to them after brief intervals, remaining 
absent for many years, visiting with great regularity the 
same places on each return, sometimes limiting itself 
with singular abruptness in certain localities, passing 
over places in its route with strange capriciousness, and 
afterwards returning to them, spreading sometimes with 
and sometimes against the prevailing winds. 

Cholera is caused by a specific poison ; of this there 
can scarcely be a doubt in any man's mind who has 
traced it from its first authentic appearance in the delta 
of the Ganges to its disappearance in St. Louis a year 
or two ago. But what is the nature of that poison, and 
how is it conveyed? How is cholera propagated or 



AND GUIDE TO HEALTH. 225 

diffused is the great question that is agitating the minds 
of the people. If we once understand how it is propa- 
gated or diffused we can to a very great extent avoid it. 
There are, no doubt, a great many circumstances that 
favor its development, and occasionally, doubtless, there 
are sporadic cases, but certainly its propagation or dif- 
fusion is mainly by contagion ; still cholera is certainly 
very little contagious in the sense in which small-pox is 
commonly called contagious, and if proper precautions 
are taken where it is present there is scarcely any risk 
that the disease will spread to persons who nurse and 
otherwise closely attend upon the sick. Dr. G. Hurt, of' 
St. Louis, Mo., has written a pamphlet on the causes,, 
prevention and cure of cholera, collecting and condensing 
all the cholera literature that has lately been published 
coming from the most eminent physicians. Later than 
the writing of Dr. Hurt's pamphlet Dr. Goodeve, who has 
been long connected with the large hospital of the Medi- 
cal College of Calcutta, has written an able article in that 
splendid book, "Reynolds' System of Medicine." To 
this article of Dr. Goodeve I am indebted for much of 
the history and many other important facts in regard to 
the cause and treatment of cholera. But I shall now 
quote from Dr. Hurt's paper : " But cholera has a certain 
peculiar contagiousness of its own now to be explained, 
which, where sanitary circumstances are bad, can operate 
with terrible force and at considerable distance from the 
sick. It appears to be characteristic of cholera — not only 
of the disease in its developed and alarming form, but 
equally of the slightest diarrhea which the epidemic in- 
fluence can produce — that all matters which the patient 
discharges from his stomach and bowels are infective — 
that the patient's power of infecting other persons is 

represented almost or quite exclusively by those dis- 
15 



226 THE FAMILY PHYSICIAN 

charges ; that they, however, are comparatively non- 
infective at the moment when they are discharged, but 
afterwards, while undergoing decomposition, acquire 
their maximum of infective power ; that, if they he cast 
away without previous disinfection, they impart their own 
infective quality to the excremental matters with which 
they mingle in the filth sodden earth or in depositories 
or conduits of filth, and to the affluvia which those excre- 
mental matters evolve ; that if the infective material, by 
leakage or soakage from drains or cesspools, or other- 
wise, gets access, even in the smallest quantity, directly 
or through porous soils, to wells or other sources of 
drinking water it can infect, in the most dangerous man- 
ner, very large volumes of water; that the infective 
influence of choleraic discharges attaches to whatever 
bedding, clothing, towels and like things have been 
imbued with them, and renders those things, if not dis- 
infected (as the cholera patient himself would be capable 
under the same condition), of spreading the disease in 
places whither they are sent for washing or other pur- 
poses ; that, in the above described way, even a single 
case of disease, perhaps of the slightest degree, and 
perhaps quite unsuspected in the neighborhood, may, if 
local circumstances co-operate, exert a terribly infective 
power on considerable masses of the population. 'If 
local circumstances co-operate,' however, is the stated 
condition for that possibility ; and it will be observed 
that the essence of the sanitary precautions which have 
been recommended to nuisance authorities and others 
is, to annihilate those 'local circumstances.' The chole- 
raic infection does not seem able largely to infect any 
population unless a filthy state of things be presupposed. 
It is presupposed that the atmosphere or the drinking 
water of the population is impure with the most loath- 



AND GUIDE TO HEALTH. 227 

some impurities — that the infective material has had 
opportunities of action which decent cleanliness would 
not have afforded it — that, in inefficient drains or 
cesspools, or other like depositories, it has had time 
to develop its own infective power and to render other 
stagnating filth equally infective with itself, and that 
from such foci of infection the disgusting leaven of 
disease has spread, in air or water, to be breathed or 
swallowed by the population. In this view of the case 
it will be understood that works of sewerage, house- 
draining and water supply properly executed and prop- 
erly used give to town populations an almost absolute 
security that cholera, if introduced among them, can 
have no means of spreading its infection. And equally 
it will be understood that, in the absence of those per- 
manent safeguards, no approach to such security can be 
got without incessant cleansing and disinfections, or 
without extreme vigilance of every possible contamina- 
tion of drinking water." 

Dr. Goodeve, speaking of the diffusion of cholera by 
human intercourse, says : " From the mass of evidence 
on this point it is impossible to doubt that in many in- 
stances-it has spread in some manner by such means 
(human intercourse)." 

Dr. Barry, in the Indian Annals for 1854, relates that 
cholera made its appearance in the military hospital at 
G-owalparah on the 27th of April, and that several cases 
afterwards occurred. The first case was that of a Sepoy 
who had just arrived with a detachment from Gowhatty. 
Now, there was no cholera at G-owhatty when he left, and 
none at Gowalparah when he arrived, but the whole de- 
tachment had, forty hours before, passed through a place 
called Palassbarree, where it was raging. It is supposed 
that the sick man brought the disease with him from 



228 THE FAMILY PHYSICIAN 

tlience. It spread, but not fast, and the first cases which 
occurred at Gowalparah were from those which passed 
through Palassbarree, their comrades who waited upon 
them in hospital, and the sick soldiers in the hospital 
into which fhey were received. 

The dispersion of the children of the Tooting School, on 
account of the fearful outbreak of cholera among them, 
in 1848, was attended with attacks and deaths among 
the children removed, and seizures among the inmates of 
some of the establishments into which they were received, 
although there was no cholera at the time in the institu- 
tions or surrounding neighborhood. 

In the report of the Indian cholera committee on the 
epidemic of 1861 some remarkable facts are stated with 
reference to the introduction of cholera into Gurwhal and 
Kumaon in 1852. The report says: "The districts of 
Kumaon and British Gurwhal lie entirely within the 
Himalaya mountains, on the borders of Rohilcund. They 
cover an area of 12,000 square miles. The population is 
very scanty, scattered for the most part in small villages, 
which are often separated from one another by vast 
mountains and tracts of forest. These districts are cut 
off from the plains of Northern India by an uninhabited 
belt of forest, and by the swampy and almost deserted 
region called the Terai. These tracts, some twenty miles 
in breadth, effectually cut off the inhabitants of the 
mountains from those of the plains. The intercourse 
between them is at all times very little, and confined to 
a few particular lines leading to places of pilgrimage or 
trade. Cholera is generally as completely absent from 
these mountains as from any part of Europe, but it has 
occasionally spread among their inhabitants epidemically 
with great violence." 

Mr. J. Straehez, C. S., the able president of the cholera 



A]SD GUIDE TO HEALTH. 229 

commission, formerly in charge of the hill district of 
Gurwhal, mentions the following facts, which occurred 
under his own immediate observation: "In the early 
part of 1852 extensive works of irrigation were in pro- 
gress at the foot of the mountain in Kumaon, in the 
Bhabur (the strip of forest land which divides the 
mountains from the plains), of which Mr. Colvin has 
spoken in his note. Several thousand workmen were 
collected from all parts of the neighboring hills. Cholera 
broke out among these people with great violence, and 
they fled panic-stricken to their homes, which were 
generally at a distance of several days' journey in the 
interior of the hills. Up to this time cholera had been 
unheard of in Gurwhal, or in any part of the neighbor- 
ing mountains. This is a fact which was carefully 
inquired into and thoroughly ascertained. Many of the 
work people who had fled from the Bhabur died upon 
the way to their homes, and many others were attacked 
when they reached their villages. The cholera broke out 
among the other inhabitants of the villages, commencing, 
in very many instances, in the families of the men who 
had brought the disease from below. For a considerable 
time cholera was entirely confined to places which had 
been in direct communication with persons suffering from 
the disease, but in the course of a few weeks it had be- 
come impossible any longer to trace such connection, and 
cholera became generally epidemic in the hills. Many 
of the first cases were carefully investigated ; it appeared 
to be proved, beyond the possibility of a doubt, that in 
many instances cholera had never been heard of in the 
villages until the arrival of the men from the Bhabur 
who were the first attacked by it." 

Although it is certain that cholera is spread by human 
intercourse, it may originate in places without it being 



230 THE FAMILY PHYSICIAN 

possible to trace any previous communication with 
infected persons. This has happened beyond a doubt. 
Its appearance in St. Kilda, in the western island of 
Scotland, is as strong an instance as could be given. 
This island was cut off from all communication with the 
main land, and yet the disease appeared in it suddenly 
without a trace of importation. In 1848 Dr. Parks could 
not trace any contagious origin for the first cases occur- 
ring in London. 

CONTAGION OF CHOLERA. 

The fact of the diffusion of cholera by human inter- 
course leads us to inquire how this operates, and directly 
to the question of the contagion of cholera. Diffusion by 
contagion does not negative the possibility of an origin 
independent of infection. It does not seem proved 
that contagion can exist in the shape of volatile poison 
emanating from the sick and rapidly infecting the healthy. 
It would not be so easy to disprove that there may not 
be some form of poison which may not be volatile, or 
which may require time to become so, or to develop its 
poisonous properties and capability of infection. It will 
be observed from what I have quoted from Dr. Hurt's 
paper, as written by Mr. John Simon, F. R. S., medical 
officer of the privy council, that this is most likely the 
case, i. e., the discharges of every description are not at 
first infectious, but that after a certain time in the course 
of their decomposition they become infective to a very 
high degree. Dr. William Budd advocates the conta- 
giousness of cholera through the medium of the dis- 
charges. His propositions are these : first, that the dis- 
ease is essentially contagious or communicable ; and 
second, that it is disseminated, as he believes, exclusively 
by the liquid discharges from the intestinal canal of 



AND GUIDE TO HEALTH. 231 

cholera patients. He also believes that the poison is 
rapidly multiplied in the human body, and that the rice 
water discharges contain the product of this multiplica- 
cation and become a source of infection ; so that from 
one cholera patient virus enough may arise to propagate 
the disease to numerous persons. He considers that the 
poison may be disseminated in the following principal 
ways : first, by the soiled hands of the attendants on the 
sick — a mode of communication which is probably within 
the limits of the family circle ; second, by means of bed 
and body linen, and other articles tainted with rice-water 
discharges ; and third, through the medium of the soil, 
which, as the discharges are liquid, necessarily receives 
the great bulk of them. The doctor thinks that from 
these places of deposition the poison may spread itself 
by rising into the air with the products of evaporation, 
by percolating into drinking water, or by atmospheric 
dispersion, in the form of impalpable dust, after it has 
passed into the dried state. 

According to this view of Dr. Budd, cholera is conta- 
gious, but in a very different form and manner from a 
volatile or gaseous emanation proceeding from the sick. 

Certainly it explains the diffusion of cholera in a more 
satisfactory manner than the ordinarily received notions 
of contagious poison. 

The conclusion is, that cholera is contagious from the 
"rice-water discharges," but not from the fresh dis- 
charges ; if so every bed next to a cholera bed in a hospital 
would be a bed of disease, every bed and bed- pan would 
be a source of cholera to every succeeding patient. 
Observation teaches that such evils do not result. Attend- 
ants and sweepers, whose business it is to remove all the 
discharges, do not suffer out of proportion to others ; 



232 THE FAMILY PHYSICIAN 

"but that the discharges, when they undergo decompo- 
sition, give off the contagions matter. 

Now, the practical lesson to be learned from this is, to 
nse disinfectants ; to attend to every discharge, either from 
the stomach or bowels, and nse disinfectants at once with 
every particle of said discharges. From all the facts 
and observations before me, of men of science and expe- 
rience, I feel authorized to say that if this conrse was 
rigidly followed, cholera wonld never spread. That 
sporadic cases do arise I have no doubt, but if every 
particle of the discharges from them were properly disin- 
fected, with some of the preparations that I shall here- 
after recommend, cholera would never spread. 

One other circumstance I will call attention to which 
seems to me to be almost conclusive in favor of the 
theory above stated. It is this: establishments con- 
taining both male and female inmates, under the same 
roof, separated from each other merely by walls or par- 
titions, and breathing the same air, eating the same food 
and drinking the same water, the only difference between 
them being the use of separate primes, the contamina- 
tion of one of these privies by discharges thrown into it 
from the first case of cholera, explaining the reason that 
the disease raged violently among one sex, and was con- 
fined exclusively to the one sex only. Certainly such 
cases are strong in favor of the above theory, and such 
cases are not at all uncommon in choleraic literature. 

SYMPTOMS. 

Disturbance of the bowels is, doubtless, the first 
symptom we have to deal with. Drs. Twining, Annessly, 
Orton, and others, mention other preliminary symptoms: 
a feeling of malaise, oppression of epigastrium, depres- 
sion of spirit, pallid, anxious and sorrowful cast of coun- 



AND GUIDE TO HEALTH. 233 

tenance, sense of exhaustion, vertigo, noise in the ears, 
headache, tremor and sense of debility. "Without 
doubt," says Dr. Goodeve, " after making due allowances 
for the fancies and terror of people during cholera epid- 
emics, preliminary disturbances of the nervous system 
have occurred, and should not be made light of. But 
it must be acknowledged that in the majority of cases 
no such forewarnings are perceived. A premonitory 
symptom, for which medical aid is often called, during 
cholera epidemics is diarrhea. The disease itself begins 
suddenly, with purging or vomiting, but in numerous 
cases there is relaxation of the bowels for some days or 
hours before the real attack begins ; the motions, watery 
or semi-fluid, sometimes pale, but not always so ; three, 
four or more in twenty-four hours, perhaps with griping. 
There may be some sense of exhaustion with this. 
There is a strong tendency to diarrheal complaints during 
cholera epidemics, and, though some of the cases may 
be harmless, many of tliem do ultimately pass into 
cliolera. * * * It is a matter of common observation 
that the attack commences with purging, very often early 
in the morning; vomiting seldom comes on till later; 
evacuations are copious and fluid. The flrst stools gen- 
erally consist of the ordinary contents of the intestines, 
mixed with much liquid. The patient often describes 
them as rushing from him in a stream. Generally the 
evacuations are frequent and copious ; they are soon 
attended with a feeling of exhaustion. This excessive 
watery purging characterizes the onset of cholera. It is 
frequently painless, but not always so; therefore we 
should not suppose that a patient has not cholera be- 
cause he has griping pain. So excessive are these evac- 
uations that in two or three hours an ordinary sized 
stool pan will be filled. With the exception of those 



234 THE FAMILY PHYSICIAN" 

first passed they are of a light straw or pale drab color. 
The name of rice-water stool has been given to the 
unmixed cholera evacuation. With purging, but gen- 
erally beginning later than it, is combined vomiting. 
The fluid vomited, if unmixed with ingesta, is clear and 
watery, often in quantities of a pint or more, and gener- 
ally ejected with force. The vomiting is less constant 
in its intensity than the purging, and sometimes is 
very slight, occurs at irregular intervals, and is readily 
excited by medicine or drink. When the rice-water 
evacuations appear, cramps generally set in — not often 
before this ; they are most frequent in the fingers and 
toes, in the calves of the legs, thighs, and sometimes in 
the abdomen. They may continue through the next 
stage. By the time the vomiting and purging have been 
established, and even in the earlier stages, the counten- 
ance becomes altered. It assumes a somewhat leaden 
hue, and has a tendency to shrinking ; a stony, staring 
look, with the capillary circulation sluggish. Alteration 
of countenance often points out the character of the dis- 
ease, even before any symptoms have been complained 
of, though they really may have existed for some hours. 
Whatever may be the state of the countenance, if there 
have been many stools or frequent vomiting, symptoms 
of depression appear, the pulse begins to lose its strength 
and soundness, and the temperature of the surface falls. 
Within six or seven hours of the onset of the purging, 
or even much earlier, the pulse may dwindle down to the 
faintest thread, or may entirely disappear from the wrist 
for many hours ; in others, even in well marked cases, 
though in milder forms of the disease, never quite ceasing 
to be felt at the wrist. This period is one of the greatest 
interest to the surgeon. With the utmost anxiety he 
watches, hour after hour, the waning, or the stationary, 



AI\ T D GUIDE TO HEALTH. 235 

or the returning strength of the pulse, its maintenance 
or its extinction heralding either a happy issue in the first 
stages, or a future struggle of the deepest danger through 
the next stage, that of collapse. 

" In some cases the balance oscilates for hours. If it 
turn adversely, with the failing circulation comes the 
shrunken face, the lessening of bodily warmth and the 
greater exhaustion, and the patient passes into the state 
of collapse. The state of collapse is very much more 
dangerous than the last. The evacuations from the 
bowels are now less frequent and less copious. The 
stomach may act violently, but with less discharge. In 
the extreme state of the collapse the patient nearly re- 
sembles a corpse. The patient becomes restless, tossing 
off his cover as if in search of cool air, or he half springs 
up in bed shrieking from agonizing cramps, or he is still 
more exhausted with irregular paroxysmal gasping 
for breath, which subsides to be again renewed, and may 
end in the respiration being more constantly embarrassed. 
He pavses his stools heedlessly, with indifference. Now 
the features are shrunk and livid, the eye-balls small 
and busier in their orbits, the lower lid drooping and the 
eye half open, the surface is deadly cold, except, perhaps, 
sometimes the forehead, the tongue icy to the touch, the 
very breath a cold air stream, the general surface pale, 
blueish or livid, often bathed in cold, profuse sweats, and 
the pulse absent from the wrist. The patient lies between 
his paroxysms of cramp in an apathetic state, heedless of 
all around him, but not comatose, perhaps, until the last. 
Thirst and sense of heat of the stomach are at times in- 
tense and tormenting — water, water, is the urgent and 
frequent supplication." 

There is no more distressing state to witness than 
that of a patient in a state of collapse from cholera. 



236 THE FAMILY PHYSICIAN 

The contrast between his state of a few hours previously, 
the sudden affliction of friends and relations, the appa- 
rent hopeless condition of the sufferer, all conspire to 
impress one painfully. But with all this hope need not 
be cast aside. The patient may lie for hours without pulse 
at the wrist, and sometimes even in the brachial artery, 
and yet recover. Cases without pulse in the brachial 
artery and manifest permanently impeded pulmonary 
circulation, with dusky and livid countenance, seldom or 
never recover, but short of this a large number do. 

The stage of collapse may last from twelve to forty- 
eight hours. The patient may die in three or four or 
more hours, the pulse never returning, the respiration 
becoming more and more impeded, and the brain more 
torpid, with onset of coma and snoring respiration, clos- 
ing in death ; or, after lasting a variable time, from five 
to twenty or more hours, the patient becomes less rest- 
less, less thirsty, and restlessness and anxiety give way 
to calm ; he dozes quietly, with easy respiration. This 
is of most favorable import. The pulse at the wrist 
flickers, we are in doubt if we do not feel some movement, 
then we are certain that we do, then this beat is unmis- 
takably established, the superficial veins show themselves 
filling at the back of the hands, the surface is less cold, 
the countenance assumes more and more its natural 
character, the temperature rises, reaction is certain. 

TEEATMENT. 

The prophylactic or preventive treatment of cholera 
is of the highest importance. Whatever may be our 
views as to the contagion of cholera, it is well to act upon 
the principle that it may under certain circumstances be 
spread in a locality. Certainly there can be but little 
doubt that the discharges from a cholera subject may 



AND GUIDE TO HEALTH. 237 

become injurious to the healthy subject ; hence they 
should never be thrown into the common privy, but be 
treated Trith chloride of zinc (a disinfectant), and buried 
in trenches out of harm's way, at some distance from 
habitations, and where no drainage from them may find 
entrance into wells or cisterns. The bed pans and other 
vessels used should also be washed with chloride of zinc 
and thoroughly cleansed. The covering, the bed clothes, 
and all linen, should be boiled in lye made from ashes, 
and well washed. There is not the slightest necessity 
for burning the linen used. Cholera patients may be 
safely nursed by their relatives or friends without run- 
ning any great risk, provided the room is well ventilated, 
kept clean, and all discharges treated at once with chlor- 
ide of zinc and removed. Nursing mothers should not 
resume suckling their children for a few days after an 
attack of cholera, and then not until the milk has been 
drawn off well for a time or two. 

Good food and pure, clean water should be especially 
attended to in cholera epidemics. All indigestible food, 
and all tainted articles, should be especially avoided. 
Great care should be taken that the water drank be pure 
and free from all fsecal discharge whatever. If water 
can not be procured from a clean, well cemented cistern, 
it would be always well in cholera times to distil it. All 
food or water likely to produce irritation of the bowels 
are to be avoided, and every one should be extremely 
cautious about the administration of cathartics during 
the prevalence of cholera epidemics ; of course, they will 
be occasionally required, but they should not be given 
without decided necessity, and then never of the hydra- 
gogue character, nor at bed time. 



238 THE FAMILY PHYSICIAN 

TEEATMENT OF CHOLEEAIC DIAEEHEA. 

We will next consider the treatment of that form of 
diarrhea that is found to prevail in and often to precede 
cholera, and which we have already observed often runs 
into cholera. The discharges must lbe restrained. This 
can almost always be done by a few doses of chalk 
mixture, with this addition : to two ounces of chalk 
mixture, twenty grains of gum kino, an ounce of brandy 
and two drachms of laudanum ; mix and give a table- 
spoonful every two or three hours until the discharges 
are checked. If the case seems to be troublesome or 
intractable, diluted sulphuric acid may be given at the 
middle of the day and flannel cloths wrung out of warm 
water, on which a dozen or so drops of spirits of turpen- 
tine have been dropped, applied over the stomach and 
bowels. If there is rice water stools the patient should 
be treated as directed hereafter for the first stages of 
cholera. Choleraic diarrhea, like cholera, is much more 
intractable and dangerous in the commencement of epi- 
demics, following, indeed, the rule of cholera itself. In 
these periods many cases run into cholera in spite of 
early and assiduous treatment. 

TREATMENT OF CHOLEEA. 

In this the great object of treatment should be to 
restrain the passage of exudation from the blood into the 
intestines. 

This contrasts with Dr. George Johnson's theory of 
elimination by purging, vomiting and diluents ; but 
from his later writings it seems to me that the learned 
Doctor has almost abandoned his former theory himself. 
He admits that the disease is usually attended with a 
profuse drain of fluid from the blood, and he says : " To 



AND GUIDE TO HEALTH. 239 

increase that drain might be mischievous and might be 
fatal." — Med. Times and Gazette, June 16, IS 66. 

" The remedies used," says Dr. Goodeve, " for this 
(to restrain the passages) generally check the vomiting 
and purging, so that in the condition of these, taken 
with the state of the pulse, we have a sort of indication 
of the degree in which the transudation is interfered 
with — a sort of indication, because there is not always 
any close relation between the time of the transudation 
and the discharges from the bowels. The first medicine 
given should be a full dose of opium — to an adult two 
grains. If this dose is retained probably little more 
medicine will be required. We must not expect the 
purging to cease immediately after the medicine is swal- 
lowed. Perhaps one or two motions will pass away after 
the dose has been given. If the medicine is vomited up 
it must be repeated in a few minutes. Half an hour 
after the opiate has been retained give sugar of lead 
thirty grains, acetic acid ten drops, and distilled water 
six ounces ; of this give half an ounce or an ounce every 
half hour or hour, according to the severity of the symp- 
toms. At the end of an hour from the time the first dose 
of opium has been taken, if the purging persists, give 
one grain more of opium and continue the drops above 
named ; if the purging still continue smartly but seems 
inclined to cease and the pulse keeps good, it may be 
left off or given at wider intervals. It is always neces- 
sary that the medicine should be presented to the stomach 
in the simplest and least irritating form. In the form 
of pill opium it is more easily retained than laudanum, 
but when a pill is not at hand forty drops of laudanum 
in a little cold or iced water or a little brandy. If the 
above medicine checks the discharges all danger will 
probably be over in a few hours. < Consecutive disease 



240 THE FAMILY PHYSICIAN 

is not likely to follow so simple a case. If there is much 
vomiting mustard should Ibe applied over the stomach. 
Cramps are generally relieved by friction with chloro- 
form or with the hand ; if severe, by the inhalation of 
small quantities of chloroform. When the collapse is 
progressive no opium should be given after the third 
grain, and indeed if it seems to be fast approaching even 
the third grain should be withheld. 

Collapse. — Dr. Johnson says : " The state of choleraic 
collapse results from a peculiar arrest of blood through 
the lungs, occasioned by a morbid poison. It is not a 
condition of mere exhaustion. It is not relieved by the 
remedies for exhaustion ; and it is made worse by opiates 
and by spirituous stimulants, which must therefore be 
avoided." To this Dr. Goodeve adds his testimony, not 
in so many words, but in principle. Dr. Johnson con- 
tinues : " The patient should be strictly kept in the 
recumbent position ; he should be allowed to drink pure 
water freely, and should be abundantly supplied with 
fresh air. Hot flannels, or bottles, or bags of sand, 
should be applied to the feet and legs. * * * 
Five grains of sesquicarbonate of ammonia, or a tea- 
spoonful of spirits of sal-volatile, may be given in an 
ounce of camphor mixture every two or three hours, as a 
diffusible stimulant." 

If ice is available, it is best to allow ice water, or to 
place pieces of clear ice in the patient's mouth frequently. 
The only necessity there is for any restriction on the 
amount of water given is that too much vomiting may be 
induced by it. It is dangerous to fill the patient's 
stomach with brandy while in this condition, as it can 
only lie there while the stage of collapse lasts. "When 
that is over it may be absorbed and produce fatal effects. 



ASTD GUIDE TO HEALTH. 241 

m 

The profuse perspiration must be kept wiped off the 
surface with a dry, soft towel. 

It is useless to try to feed the patient during the stage 
of collapse, the power of digestion is entirely suspended. 
Any nourishment administered at this time only adds to 
the feeling of oppression and distress, from which the 
act of vomiting only gives relief. 

After reaction, and when the normal secretions are 
restored, the mildest nourishment should be given, in 
very small quantities but often. It may consist of milk, 
gruel, rice or beef tea, chicken broth, &c. A little 
good native wine or brandy toddy may now be used. 
Care should be taken to treat any symptom that should 
arise during convalescence. 

This system or plan of cholera treatment may to some 
seem too simple and inefficient for a disease so formid- 
able, and one that has proved so destructive to human 
life. To such I would say, that a few simple remedies 
properly applied are calculated to do vastly more good 
than a host indiscriminately and injudiciously used. In 
this connection I will make a quotation from an article 
in the Medical Times and Gazette, April 14th, 1866, 
written by Dr. Bowerbank. The Dr. says : " I have seen 
drugs without number tried, and have heard each and 
every one cried up for a time as a specific and certain 
cure, but have seen them again fail and put aside. I 
have seen and tried small and repeated doses of calomel; 
also large doses of the same ; also small and monstrous 
doses of acetate of lead, the mineral acids, the alkalies, 
the opiates, quinia, ipecacuanha, belladonna, mineral 
and vegetable astringents, cajuput oil, croton oil, castor 
oil, turpentine, creosote, nitrate of silver, sulphate of 
magnesia, tartar emetic, mustard, table salt in large 

doses, Stevens' saline powders, charcoal, chlorate of pot- 
16 



242 THE FAMILY PHYSICIAN 

• 

ash, eupatoria or bitter "bush, the fresh juice of the aloe, 
and many others ; spirituous stimulants to intoxication, 
carbonic acid gas, the so-called Liverpool mixture, and 
other boasted formulae ; warm baths, hot air baths, ex- 
ternal friction, enemata of all Jcinds, saline injections 
into the veins ; but, nevertheless, I fear the results have 
been very unsatisfactory on the whole. Few of the first 
cases got well, and if they did, I couldn't satisfy myself 
that their doing so was the result of what they had 
taken." 

Would you have the victim murdered by the use of 
pernicious drugs. "We have no specific for cholera, but 
must treat it like many other diseases, on general prin- 
ciples. The principle I have laid down is to check the 
discharges, and to restrain the passage of exudations 
from the olood into the intestines. If this is done early, 
the case always recovers ; if it is not accomplished, the 
patient passes from one stage to another until death re- 
lieves him from, his sufferings. 



AND GUIDE TO HEALTH. 243 



GOUT. 

( GERMAN— GICHT.) 



Gout is an old disease ; it was well known to Hippo* 
crates ; Ms account of the disease shows he was well: 
acquainted with many of its silent phenomena. From 
that time down almost every writer has made reference- 
to the subject. It is a disease of rather common occur- 
rence in some countries where people live high and take 
insufficient exercise. This does not only produce it m 
them, hut it is entailed, or, in other words, it is heredi- 
tary. Some individuals are, undoubtedly, more disposed 
to gout than others. There is, in short, a proclivity to 
gout which may be inherited ; and it is certainly true as 
regards this malady that the sins of the father are 
visited upon the children to the third or fourth generation- 

SYMPTOMS. 

Dr. Alfred Baring Garrod describes an attack of acute 
gout in this language: "In many instances the first 
attack of articular gout comes on without previous 
warning, or, if there be premonitory symptoms, they 
are so slight as to pass unnoticed by the patient. This 
absence of warning, however, is by no means so common 
as is usually supposed ; and I have met with several 
cases in which the premonitory symptoms have been 
very distressing, although before the seizure they were 



244 THE FAMILY PHYSICIAN 

not suspected of being the precursors of any joint affec- 
tion. Under ordinary circumstances an individual retires 
to rest in his usual health, but early in the morning, 
usually from two to five, awakes with an uneasy feeling, 
probably confined to one of his great toes ; on attempting 
to place his foot on the ground he finds himself unable 
to support the weight of his body, or, if capable of so 
doing, the act is accompanied with great pain. If the 
painful part, generally the ball of the toe, be examined, 
it is found to be swollen, red, hot and exquisitely tender, 
and sometimes to such an extent that the mere weight of 
the bed clothes is intolerable, and even the vibration of 
the room causes discomfort. The veins proceeding from 
the toe are tinged with blood and the joint stiff. 
Although, occasionally, no constitutional disturbance is 
present, yet most frequently there is evidence of slight 
fever ; the patient has a feeling of chilliness, followed 
by heat of skin and perspiration, some thirst and loss of 
appetite, a white tongue and confined bowels, with great 
restlessness, and is unable to find an easy position. The 
urine is usually small in quantity, high colored, and 
deposits, on cooling, a sediment varying in color from 
pale buff to brick-dust red ; occasionally, when febrile 
disturbance runs high, the fur which encrusts the vessel 
is of intense pink color ; cramps of the legs are often 
present during an attack and add much to the suffering 
of the patient. 

" If moderate precautions are taken, and the foot kept 
in a horizontal position, the inflammation usually sub- 
sides in the early part of the day ; but at evening an 
exacerbation takes place, and for the greater part of the 
night the patient is kept awake by the pain, which again 
subsides as morning advances. 

" After a day, or as soon as the swelling decreases, con- 



AND GUIDE TO HEALTH. 245 

siderable relief is experienced, and in a few more days 
the tension becomes diminished, as well as the heat and 
livid redness, and slight sustained pressure will then 
cause distinct pitting. Subsequently, as the disease dis- 
appears, disquamation of the cuticle takes place, and, 
occasionally, the skin pulls off in flakes of considerable 
size. Not all cases, even of first attacks, assume this 
sthenic form ; in weakly subjects, and especially in 
women, the fit may have an asthenic character ; the pain 
and heat may be slight, the redness and swelling by no 
means well marked, yet, as far as ultimate mischief is 
concerned, this variety is much worse than the other. 

" The duration of the joint inflammation varies consi- 
derably in different cases, and is much influenced by the 
diet and regimen adopted, and likewise by medicine 
administered. If let alone it will not subside under a 
week or ten days or more. The fit may be reduced by 
proper treatment to four or iive days. After the complete 
subsidence of the joint affection the patient often 
expresses himself as feeling lighter and altogether better 
than before the occurrence of the attack. 

" It is not an uncommon occurrence for both great toes 
to be attacked, even in a first fit of gout, sometimes 
simultaneously, but more frequently alternately, the 
inflammation rapidly subsiding in one toe and as quickly 
appearing in the other. Sometimes other joints or the 
ankle are affected with it at the same time as the toes, 
and occasionally the knees, or, more rarely, some of the 
joints of the upper extremities. 

" In many instances some two or three years elapse 
before the recurrence of the second attack ; but in the 
majority of cases not more than twelve months, and then 
either the same joint as in the first seizure or the corre- 
sponding joint in the other foot is usually affected. 



246 THE FAMILY PHYSICIAN 

Similar intervals elapse between the next few paroxysms, 
and again the same joints are implicated or the inflam- 
mation extends along the foot involving the articula- 
tions of the arch and of the ankles. As time goes on 
the disease becomes more general and almost every joint 
of the extremities suffers, those of the lower usually 
taking precedence of the upper limbs. In the course of 
years the intervals between the attacks diminish still 
more — the yearly visitations become half yearly ; after- 
wards the attacks recur every few months, until at length 
the patient can scarcely calculate upon being free at all 
from his malady so numerous and uncertain are its visi- 
tations. Gouty inflammations never lead to the formation 
of pus. An inflamed joint may be intensely red, even 
scarlet, the skin shining from the distention, and it may 
altogether exhibit the appearance of suppuration, yet 
all these symptoms quickly subside, and by resolution 
merely." 

Alcoholic drinks both lay the foundation of gout and 
excite the attacks of the disease. Distilled spirits cer- 
tainly have much less tendency to produce gout than 
either wine or malt liquors. Gout occurs largely in 
England, even among the the laboring classes who do not 
live very high, but drink an enormous quantity of "hale" 
and " 'alf-and-'alf," while among the laboring classes of 
Edinburgh, Glasgow, Poland, Russia and America, 
up to a few years ago, the drink was almost entirely 
whisky and in large quantities. In countries where 
the lighter kinds of wine form the chief beverage of a 
large class of the people gout is very rare, as for 
example the working population of France, also of Italy 
and in most parts of Germany ; but it is asserted that in 
certain parts of Germany, as in Berlin and Munich, 



A^D GUIDE TO HEALTH. 247 

where malt liquor is largely consumed, the disease is 
much more prevalent. 

TKEATMENT. 

Our attention must first be given to the articular 
inflammation or the painful joint. For this purpose 
there is one ■ drug which has an undoubted influence in 
controlling gouty inflammations, and its action in articu- 
lar gout appears as marked in gout as that of quinine in 
ague or tincture of iron in erysipelas ; this remedy is 
colchicum. It signifies not what part of the colchicum 
plant is taken, whether the corm, the seeds or the flowers, 
for the same principle pervades the whole plant ; neither 
does it signify what preparations are made use of, 
whether the wine, the tincture or the extract, provided 
equivalent doses be administered, for the effects of all 
are the same. 

Dr. Alfred B. Garrod says : " Colchicum has a direct 
controlling power over the joint disease (speaking of 
gouty articulation), and I can not call to mind a single 
instance in which its influence was not well marked, 
although in many cases a question may arise as to the 
propriety of its exhibition. Colchicum in full doses pro- 
duces a marked sedative effect upon the nervous and 
vascular systems ; it has a distinct influence upon the 
intestinal canal, and, if continued too long and in too 
large doses, causes tormina and a very troublesome form 
of diarrhea. * * * Although colchicum causes 
purging, still its peculiar influence is quite apart from 
this effect. Occasionally an almost magical change is 
produced by a single strong dose, without the appear- 
ance of the least increase in the secretions from any 
organ, the effect being manifested in the rapid subsidence 
of the pain and other symptoms of the joint Mamma- 



248 THE FAMILY PHYSICIAN 

tion ; and simple purging, even though copious, will often 
fail to produce any notable effect under the same circum- 
stances. I am of opinion that in articular gout colchi- 
cum may be advantageously administered during the 
time that the inflammatory symptoms are present, and 
the dose of the wine of colchicum may he from ten to 
twenty, or even twenty-five, minims (drops), repeated 
every six hours. Colchicum in the above manner will 
of itself be sufficient, in most cases, to cut short the gouty 
attack, and I have often depended on it alone." 

The alkaline plan of treatment is likely to prove ad- 
vantageous, both for the purpose of increasing the 
alkaline state of the fluids, and also to keep in solution 
the salt of uric acid, which is liable to be deposited in 
the cartilaginous and ligamentous tissues. There can 
be no doubt of the value of alkaline remedies in the 
gouty paroxysm ; and in many cases such salts, given 
in a freely diluted form, are sufficient of themselves for 
its removal, and are particularly applicable when there 
are circumstances rendering the administration of col- 
chicum unadvisable. Soda is the least applicable of any 
of the alkalies, unless there be imperfect action of the 
liver or a deficient secretion of bile, as it has much less 
power than the other fixed alkalies of dissolving or hold- 
ing in solution uric acid. The salts of potash are, in the 
majority of cases, more suitable than the salts of soda, 
as they not only exert a much greater solvent action upon 
urate of soda, but likewise augment in a greater degree 
the excretion of the urine. 

If the patient is at all costive his bowels must be 
opened with the citratized magnesia, and the functions of 
the skin, which are almost always defective, may be pro- 
moted by the use of the spirit vapor bath once a day ; at 
the same time acetate of ammonia may be given. The 



AND GUIDE TO HEALTH. 249 

patient should use diluent drinks freely, and occasionally 
saline cathartics— not actively, however, but occasionally. 

If the pain is extreme or the patient is very intolerant 
of it, anodynes must be used. For this purpose the bella- 
donna ointment may be used or smeared over the affected 
part. 

In the treatment of chronic gout colchicum is highly 
recommended ; so also is tincture of guaiacum. But, cer- 
tainly, reliance may be had better on iodide of potassium, 
two drachms in syrup of sarsaparilla or water, four 
ounces to be taken — one teaspoonful three times a day. 
In connection with this the patient should use freely the 
tincture of Peruvian bark or quinine. Carbonate of lithia 
dissolved in acetated water may be given in doses of 
from five to ten grains once or twice daily ; the quantity 
of water should be large, say four ounces or more. 
Alkalines, administered for the purpose of holding in 
solution uric acid and allowing it to be eliminated from 
the system, should always be administered in a very 
diluted form. 

The diet in the treatment of different forms of gout is 
of great importance ; far more so than in the majority of 
diseases. When the affection is acute in character and 
the patient robust he should be confined for a few days 
to a diet consisting of only bread, sago, tapioca with 
milk, water toast, rice, &c. ; his drink may be freely of 
cold water. Stimulants are scarcely necessary in this 
case ; still if the patient has been long accustomed to 
high living a little brandy toddy should be allowed him, 
but no wine or malt liquors. 

When the febrile symptoms have abated a more gen- 
erous diet must be allowed ; at first fish, then game or 
poultry, and then ordinary meat, but not too freely. 
Eating and drinking, with poor exercise, has most likely 



250 THE FAMILY PHYSICIAN 

"been the cause of the disorder. Need we expect a cure 
unless this excess and error is corrected. Then the 
patient must not drink malt liquor or any of the heavy 
wines, must eat in moderation, of a good, nutritious and 
easily digested diet, and take plenty of moderate exer- 
cise, and, if he can afford it as well as not, a trip to some 
of the mineral watering places. Gout generally develops 
slowly, and it will be found to be slow to get rid of, but it 
is clearly under the easy control of medicine, and only 
wants perseverance and patience with rightly directed 
efforts for its cure. 



A]S"D GUIDE TO HEALTH. 251 



RHEUMATOID ARTERITIS. 



This is a form of inflammation of the joints, accom- 
panied with little or no fever, and distinguished from 
gout and rheumatism by its progressive character, by 
the peculiar morbid changes which it induces, and by 
the absence of any known morbid state of the blood. 

It will perhaps be necessary to give some explanation 
of the new name, rheumatoid arthritis. On more than 
one occasion in this work we have called attention to the 
importance of a name, and have stated why and how an 
improper name was calculated to mislead the mind and 
produce confusion. One name is enough for anything, 
if it is properly selected and describes the thing or con- 
dition. This disease has been called rheumatic gout, 
chronic rheumatic arthritis, chronic rheumatism of the 
joints, nodosity of the joints, usure des cartilages articu- 
laris, rheumatism noueux. The term rheumatoid arth- 
ritis was applied to this disease by Dr. A. B. Garrod. 
Such a mass of names are only calculated to confuse the 
mind ; they show how careless men are in regard to the 
use of a name. Rheumatic gout is the name commonly 
given to the disease, both by the profession and the 
public ; but it is difficult to arrive at its true significance, 
seeing that but few have described it as a separate dis- 
ease. The term has also been used to signify very dif- 
ferent diseases. It is not uncommon to hear gouty 
patients say they are suffering from rheumatic gout, 



252 THE FAMILY PHYSICIAN 

simply because the disease, which for many years was 
manifested in the feet only, now implicates other joints, 
as the elbows and hands ; in fact they regard their 
malady as gout when it is confined to the feet, but as 
rheumatic gout when it affects the upper extremities. 
Sometimes the sub-acute forms of true rheumatism are 
designated as rheumatic gout, and more especially if the 
smaller joints are the seat of the attack. There exists, 
however, a third disease, distinct both from gout and 
rheumatism, to which we apply the name rheumatoid 
arthritis. 

Chronic rheumatic arthritis is objectionable, because 
the disease is sometimes acute, and we do not believe it 
partakes of the nature of true rheumatism. The same 
obj ections apply to the name, chronic rheumatism of the 
joints; usure des cartilages "articularis (wasting of the 
articular cartilages) is an expression very limited in its 
meaning, it only expresses one of the morbid changes 
which result from the disease. Nodosity of the joints 
and rheumatism noueux express the presence of a fre- 
quent alteration in appearance caused by the affection 
(one not always found). 

The term rheumatoid arthritis should be employed for 
the following reasons : The disease is one chiefly affect- 
ing the joints, and is of an inflammatory character, hence 
the name arthritis; it is also one which, at least in its 
early stages, produces external changes closely resem- 
bling those caused by sub-acute forms of rheumatism ; 
but, as it can be shown that the nature of the affection 
is not the same as that of rheumatism, the prefix " rheu- 
matoid" instead of "rheumatic" is sufficiently expressive. 
As the word typhoid is allowed for the purpose of desig- 
nating a form of fever somewhat resembling, but not 
identical with, typhus, so no objection can be raised to 



a:n"d guide to health. 253 

the use of the prefix rheumatoid when it is intended to 
signify that the articular inflammation, although not of 
the same nature as rheumatism, yet resembles it in some 
of its characters, and more especially in those which are 
readily appreciated "by the senses. It is only since the 
time of Haygrath that it has been looked upon by any 
pathologists as an independent disease, and now it is 
often described under the name of chronic rheumatism, 
rheumatic gout, &c, and classed as a variety of some 
other affection. 

SYMPTOMS. 

It is met with either as an acute or chronic disease, 
but most frequently as chronic, and in this form I will 
now notice it. 

A person of either sex may have become from some 
cause or other debilitated, is exposed to cold, and after a 
few days feels some pain in the knee, there is slight swell- 
ing and tenderness, perhaps the temperature is a little 
elevated; simple rest to the joint may be followed by 
relief, or even a cure for the time, the swelling abating 
and the tenderness and pain vanishing. After a few weeks 
or months, as the case may be, perhaps from a second 
chill, another joint or even that which was previously 
implicated becomes affected, and a similar train of symp- 
toms arises, but with this important exception : that in 
all probability the inflammation does not again subside, 
but continues fixed to the joint and gradually extends to 
others. During this time there may be no appreciable 
constitutional disturbance beyond the general ill health 
above noted, but in some cases dyspepsia or nervous 
symptoms are exhibited. The disease, if unchecked, 
travels over the whole body, affecting almost every joint 
and sometimes causing much deformity, distortions, en- 



254 THE FAMILY PHYSICIAN 

largement, contractions, &c, rendering tlie patient a help- 
less cripple throughout life. 

The above example is, indeed, one in which the disease 
has affected all the mischief it is capable of; fortunately 
it does not always proceed to this length, but is arrested 
at some stage or other of its progress, and then only a 
limited amount of distortion is produced. These de- 
formities have often, if, indeed, they have not always, 
been attributed to rheumatism, which is never the case ; 
rheumatism does not produce any such results, or at least 
any distortions or deformities. If the patient has been 
thought to have rheumatism and has been treated accord- 
ingly, the diagnosis and treatment have both been wrong. 
I feel confident that much of the ill success in the treat- 
ment of rheumatism may be attributed to this cause. In 
rheumatoid arthritis the deformities produced in the 
hands and arms, when severely affected, are of the follow- 
ing kind : The elbow is flexed, perhaps at an angle of 
35° from full extension; the fore arm is in a semi- 
pronated position; the joint is also much enlarged and 
misshaped, more or less rounded from the alteration, 
hypertrophy of the heads of the bones, as well as of the 
soft tissues ; the wrists are rigid and almost straight, 
and scarcely admit of motion in any direction ; the hands 
are usually thin from the absorption of fat and wasting 
of the other tissues ; the fingers are usually turned out- 
ward and their joints rigid, often completely fixed. One 
or every finger on a hand may be crooked about out of 
shape and fixed rigidly so, presenting a very homely ap- 
pearance. The knees, elbows, hips or some part of the 
spine may be thus affected, rendering the patient a very 
" ungainly" cripple. Little hard knobs about as large 
as a pea may be found situated on the ends of the fingers 
or in the inside of the hands, where they remain through 



AND GUIDE TO HEALTH. 255 

life, being usually attended with little or no pain, and, 
though they cause but slight inconvenience, are decidedly 
unsightly. Heberden thought they had connection with 
gout and called the disease " digitorumnodi." This dis- 
ease was doubtless rheumatoid arthritis ; such phenomena 
often occur in it and in no other disease. 

In the acute form now and then cases are met with 
which, in most of their symptoms, closely resemble acute 
rheumatism ; several joints are attacked, the swelling is 
considerable, there is distinct increase in the temperature 
of the affected parts, with pain, tenderness and redness. 
In these instances constitutional symptoms, as thirst, 
loss of appetite, heat of the surface, a rigid pulse and 
other evidences of febrile excitement are often observed. 
There are, however, wanting some of the charateristics 
of rheumatic fever, namely, the profuse sweating and 
the proneness to acute inflammation of the internal and 
external membranes of the heart, so common in acute 
rheumatism, and likewise the erratic disposition or ten- 
dency of the inflammation to fly from joint to joint. By 
observing these points of difference no one will fail to 
readily distinguish between the two. 

TREATMENT. 

The early treatment of this disease is of the utmost 
importance when the joints as yet are not seriously or 
irremediably injured. Of the treatment Br. Alfred B. 
Garrod writes, "From what has been stated under the 
causes and pathology of rheumatoid arthritis, it will be 
naturally inferred that a prolonged sustaining plan of 
treatment is imperatively called for, and that all depleting 
measures must tend most materially to increase the 
rapidity and severity of the disease. I have witnessed a 
great number of cases in which depletion has been per- 



256 THE FAMILY PHYSICIAN 

severed in for a time, and with the effect of producing 
lamentable results, as the joints become perfectly disor- 
ganized ; and in many of these it is probable an opposite 
treatment would have been attended with different 
results." Colchicum, so fine a remedy for gout, is in this 
disease worse than useless, producing positive harm, 
while the alkalies, so serviceable in rheumatism, are of 
no value in this disease. But one general and positive 
rule can be laid down as applicable to all cases, and that 
is, the supporting and sustaining plan must be adopted 
from the first and continued throughout the course of the 
disease. If the disease has been caused by hemorrhage 
of any kind or a seeming poverty of the blood, some of 
the preparations of iron must be given and continued 
for a long time. 

In certain conditions, where the nutrition is imperfect, 
from causes often unable to be defined, cod liver oil may 
be given with great advantage ; if the habit is materially 
improved by it the progress of the joint affection is 
usually checked. Cod liver oil is particularly indicated 
in patients of spare habit, and when the disease has been 
attended with wasting of the body. 

If the nervous system has been implicated by depres- 
sing causes, such as grief, anxiety, prolonged attendance 
on sickness or other causes, nervines must also be given — 
tincture of valerian one teaspoonful, with tincture of 
Peruvian bark, two teaspoonfuls three or four times a day. 
If the circulation is very languid, tincture of guaiacum 
with tincture of the barks must be given ; this prepara- 
tion seems to have a good influence on the skin and gives 
it a little glow of heat. Fowler's solution may, in ten 
drop doses, three times a day, be of great service. Iodide 
of potassium is also a good remedy in this complaint, in 
connection with quinine or tincture of barks. But, per- 



AND GUIDE TO HEALTH. 257 

haps, the best remedy, in connection with a proper conrse 
of supporting diet is, syrup of iodide of iron, in doses of 
from twenty to thirty drops, three times a day, and con- 
tinued for some months. The mineral waters recom- 
mended for gout and rheumatism must not be used in 
rheumatoid arthritis ; if they are it will result in much 
mischief. The stronger saline and alkaline waters must 
not be used in this disease. The chalebeate waters would 
be good, but no others. Change of air, occupation and 
scenery, by aiding the general health, exert a beneficial 
influence upon the progress of the malady. 

As a local application Dr. Garrod recommends blister- 
ing or the use of the cantharides liniment. " It produces^ r 
he says, " in almost all cases, full vesication, and r with 
little annoyance, it can be frequently applied so as to 
produce a series of flying blisters." " Under this treat- 
ment," says the doctor, " the effusion will often quickly 
subside, and the tenderness become much lessened, or 
even removed, and the liability to serious or permanent; 
injury of the joint is thereby greatly lessened." 

Plasters, such as the " arnica plaster," when the affec- 
tion in any joint has become more chronic, and blisters 
have affected all they are able to accomplish, may be 
used with great advantage, as they both render support 
to the parts and produce a little irritation. Tincture of 
iodine painted on the affected parts is often of service,, 
as well as spirits and the belladonna liniment. The 
affected parts should be well sponged, as well as the 
whole body, with salt water, and then rubbed dr}^. The 
joints affected may be moved some, which will be of 
service to them, but care should be taken not to allow 
them to be moved enough to cause any increased soreness. 
in them next day. 

With regard to alcoholic drinks, which ever kind! 
17 



258 THE FAMILY PHYSICIAN 

causes the patient to eat with most relish and digest 
with most comfort, should be selected, whether ale, wine, 
gin or brandy. 

Solid animal food of the best kind may be used freely, 
if the stomach will digest it. 

A residence in a tolerably warm country during the 
winter months is desirable, but the air of the place 
should be dry .and bracing. Such a climate will enable 
the patient to take exercise and have fresh air at times, 
when otherwise he would be confined to his house. 

The clothing should be warm, but much perspiration 
avoided. 



A^D GUIDE TO HEALTH. 259 



RHEUMATISM 



Rheumatism is a specific inflammation of the structure 
in and around the joints, attended with great febrile dis- 
turbance ; erratic ; not accompanied with urate of soda, 
and (?) not leading to suppuration. 

Rheumatism may be described as acute and sub-acute. 
This disease is sometimes called rheumatic fever, arth- 
ritis, articular rheumatism, muscular rheumatism, &c. 
Rheumatoid arthritis and gout have all been described 
and treated as rheumatism. No wonder the disease has 
proved, in a majority of cases, a very troublesome and 
obstinate complaint. Take any half dozen diseases you 
can select and subject them all to precisely the same 
treatment, and many difficulties will present themselves. 
Gout is a disease, rheumatoid arthritis is a disease, rheu- 
matism is a disease, and rheumatoid myositis is a disease, 
each separate and distinct as intermittent, remittent, 
typhus, typhoid and yellow fevers; and until they are 
studied and treated as separate diseases the treatment 
can never be successful. Now, there are certain promi- 
nent features and characteristics peculiar to each of these 
diseases that will readily distinguish them from each 
other. No one will fail to see this when he carefully 
looks over the symptoms and studies each individual 
case. 

SYMPTOMS OF ACUTE EHEUMATISM. 

We will try to illustrate the subject by giving a sketch 
of an acute attack of rheumatism. A person, possibly 



260 THE FAMILY PHYSICIAN 

somewhat out of health, is exposed to very severe cold, 
or to cold and damp conjoined; he feels a distinct 
chill or rigor, which is followed during the second or 
third day from the exposure by a development of the 
joint affection ; the ankles become painful and unable to 
bear the weight of the body, and on examination they 
are found to be tender on pressure, swollen, unduly hot, 
with a distinct flush upon the surface ; at the same time 
the system exhibits a state of febrile excitement, the 
pulse is rapid and commonly hard, the whole surface 
hot and bathed in perspiration, having a peculiar acid, 
or at least acrid, odor. The tongue is coated with a 
black, creamy fur ; there is loss of appetite, but increased 
thirst, and constipation of the bowels ; the urine is usually 
scanty and high colored, and gives rise, on cooling, to a 
copious red deposit. The inflammation is seldom con- 
fined to one joint, but gradually extends over the whole 
body. The larger joints are more frequently affected 
than the smaller ones in the early period of the attack. 

The erratic nature of the affection is usually well 
exhibited ; at one time the knees and ankles, at another 
the elbows and wrists suffer, and not unfrequently the 
development of the inflammation in one set of joints is 
accompanied by its rapid subsidence in another. 

A symmetry is often shown in the order of attack ; the 
right ankle, then the left, and so on for the other articu- 
lations. It is a matter of astonishment to observe how 
quickly and completely the inflammation will subside in 
any part ; a knee, for example, will one day be intensely 
hot and swollen, and so exquisitely tender as not to bear 
the weight of the bed-clothes, but on the following day 
will scarcely show any evidence of its previous suffering. 
This condition of the patient may continue for many 
days, or even weeks. Its usual duration, when under no 



a:n"d guide to health. 261 

special treatment, is from two to four or five weeks ; "but 
perhaps no disease exhibits greater difference in this 
respect; cases are occasionally met with which spon- 
taneously terminate in five or six days, and others which 
run a course of six or eight weeks. The pain of the 
joints and the febrile excitement is greater at night than 
during the day. 

In this form — and this form only — of the disease the 
covering or lining membrane of the heart, or even the 
substance of that organ, becomes implicated, and peri 
and endo-carditis ensue. Sometimes the heart disease 
follows a somewhat sudden subsidence of the joint in- 
flammation, but more commonly the articular and cardiac 
affections run a simultaneous course. 

In a very large percentage of the cases of acute rheu- 
matism proper the lining membrane of the heart be- 
comes implicated. The pleura and peritoneum may also 
be implicated in this form of the disease. "When the 
heart is implicated delirium is usually present, especially 
at night. In some few cases the rheumatic inflammation 
may attack the membranes of the brain, and all the 
symptoms of cerebral meningitis are produced. Some- 
times the membranes of the spine are involved, and spinal 
meningitis is set up. 

SYMPTOMS OF SUB-ACUTE EHEUMATISM. 

From various causes, the nature of the patienfs con- 
stitution or the presence of cardiac complications, rheu- 
matism assumes a sub-acute form. The joint symptoms 
remain, but in a much less severe degree, and the febrile 
disturbance peculiar to the acute form is absent. Such 
a condition may continue for weeks, months, or even 
years ; at one time relieved, at another aggravated, and 
the disease may then be compared to a similar form not 



262 THE FAMILY PHYSICIAN 

unfrecjuently seen in gout, and to which the term chronic 
is applied. The disease in this condition is most trouble- 
some, the articulated surface affected may "be in the 
upper part of the spine, in which case there are cardiac 
complications, which gradually grow worse from year to 
year, augmented Iby each aggravation of the spinal diffi- 
culty until it "becomes almost continuous. 

In sub-acute rheumatism there is often some tenderness 
of the joints, slight swelling and heat, but the disease 
differs from both chronic gout and rheumatoid arthritis, 
inasmuch as it may continue for a long time without 
leading to any deformity or permanent injury to the 
articulations. It will be observed that these statements 
are at variance with those commonly met with in works 
on this disease, in which the results ascribed to sub-acute 
rheumatism are so formidable. This difference is easily 
explained ; the results had by rheumatoid arthritis have 
hitherto been ascribed to sub-acute rheumatism. Persons 
who have suffered from one attack of rheumatism are 
very susceptible to a return or to other attacks, all of 
which will be likely to assume the sub-acute form. 

CAUSES.. 

Among the causes of rheumatism may be enumerated 
hereditary predisposition ; of this there can be but little 
doubt in the mind of any one who has taken the trouble 
to examine statistics. Cold may be set down as the most 
prominent cause, as the tables collected by different 
authors show most conclusively. 

TEEATMENT. 

Like most all troublesome diseases that can not be 
cured or cut short, rheumatism has its " thousand and 
one" remedies — each one a " specific." Every old woman 
and some of the young ones, and three-fourths of the men, 



AND GUIDE TO HEALTH. 263 

white, black and copper-colored, can tell you a specific . 
for rheumatism. This is not to be attributed to any desire 
on their part to play deception, for they have confidence 
in their remedy ; and why ? Simply this : a great number 
of severe cases of rheumatism get rapidly well without 
the administration of any drugs at all; the drug that 
happens to be used in cases of this kind is afterwards 
considered a specific, and as such handed from one to 
another. Dr. Grarrod says : "I am quite certain that 
many cases even of severe rheumatic fever get rapidly 
well without the administration of drugs, and on simply 
colored or camphor water the improvement is often so 
quick and satisfactory that had not the nature of the 
treatment been known, great virtue would surely have 
been ascribed to it ; on the other hand, in many instances, 
the disease runs a lengthened course with many partial 
relapses ; such tardiness is often found under other plans 
of treatment." 

Numerous plans have been proposed for the treatment 
of rheumatism, such as bleeding, blistering, antimony, 
mercury, colchicum, nitre and the alkaline treatment. 
These all have had their advocates and their day of 
clouded glory ; their sun soon, however, setting in a 
dark mist that has at last made them almost invisible 
to men of true science in the present day. Such men 
consider it feasible to leave the case to nature, merely 
taking care that the patient is placed under the most 
favorable circumstances, and simply given expectant 
treatment. Many practitioners, who would unhesita- 
tingly prescribe either a depleting or powerfully stimu- 
lating course of treatment, would shrink with alarm from 
the very idea of letting nature have her own way. Of 
the above plans of treatment it is only necessary here to 
say that but one of them, and that is the saline and 



264 THE FAMILY PHYSICIAN 

alkaline plan, has any just claims upon our confidence. 
Before recommending it, it will be necessary to define 
clearly what we mean Iby the saline and alkaline treat- 
ment. 

There are certain saline remedies which, after absorp- 
tion into the system, are eliminated by the kidneys in 
the same state as when they enter the stomach. For 
example : (1), nitrate of potash, chlorate of potash, and 
other salts in which the base is conjoined with a mineral 
acid ; (2), alkaline salts with carbonic acid, in the form 
of the neutral or bicarbonate of the base ; (3), salts with 
alkaline bases united with vegetable acid, as citric or 
tartaric acid. Although these salts are neutral in reac- 
tion, when introduced into the stomach they become 
speedily altered in the blood, the acid is decomposed, 
and a carbonate of the base appears in the urine ; and 
hence, although they produce no alkaline effect upon the 
mucous membrane of the alimentary canal, yet upon 
the blood and the secretions their alkaline effect is well 
marked. Saline remedies have sometimes been employed 
in small doses, simply for the purpose of acting upon 
the secreting organs ; at other times they have been given 
in very large doses, in order to alter the character of the 
blood itself or powerfully influence the vascular system. 
For this purpose the nitrate of potash seems to stand at 
the head of the list. This remedy seems to have been 
introduced about one hundred years ago, by Dr. Brock- 
elsly ; he gave it in gruel, in weak solution, 120 grains to 
the quart ; as much as an ounce of the nitrate should be 
taken in twenty-four hours. And Dr. Basham says one, 
two, or even three ounces of the nitrate, freely diluted, 
may be taken in the twenty -four hours. He also con- 
siders the local application of nitre of great value in 
relieving pain and swelling of the joints. The nitre 



AND GUIDE TO HEALTH. 265 

treatment, upon the whole, seems to have been followed 
by good results. 

Alkaline Treatment. — This, in connection with quinine, 
seems to me to be the only treatment the present state of 
the medical science can offer, and cases that will not yield 
to it can scarcely promise themselves any thing from any 
other that has ever been proposed. 

The over acid state of the body and increased amount 
of fibrin in the blood would naturally suggest the value 
of alkaline remedies. Dr. Fuller and Dr. Garrod both 
have used the alkaline treatment for a long term with 
excellent results, and with one result that is particularly 
satisfactory — i. e., in no case where the alkaline treat- 
ment had been used by them for forty-eight hours did 
any heart disease or cardiac symptom appear. This 
seems to be the experience of others. If this be a fact — 
and from all the lights before me I can not doubt it — it is 
of itself alone a recommendation to which no other 
course of treatment has any claim. If it protects that 
great important organ from the ravages of rheumatism 
it disarms it of its terror, for its only road to death lies 
in that direction ; in consequence of this it is justly 
entitled to stand higher than any other plan of treat- 
ment. The plan consists in administering a dilute solu- 
tion of bicarbonate of potash in about thirty grain doses, 
every four hours, until the joint symptoms and febrile 
symptoms have completely disappeared. These doses 
produce no inconvenience either to the stomach or 
bowels ; the urine is not notably increased, but its 
character is completely altered, and the reaction becomes 
either neutral or alkaline. Upon the heart the alkaline 
bicarbonate acts as a sedative, reducing the frequency of 
the pulse sometimes forty-eight beats in the minute, but 
not causing any faintness. Guaiacum is valuable in the 



266 THE FAMILY PHYSICIAN 

subacute forms of rheumatism ; it should be given in the 
tincture. 

Quino-alTcaline treatment is, in my opinion, in all ma- 
larial districts the proper treatment for rheumatism, both 
acute and sub-acute. It consists in combining the two 
articles together thus : sulphate of quinine is rubbed up 
with a solution of bicarbonate of potash, to which a little 
mucilage and some aromatic, as tincture of cardamoms or 
spirits of chloriform, is subsequently added ; each ounce 
and half dose contains five grains of quinine and thirty 
grains of the potash salt, the quinine being reduced to 
the state of carbonate. To the adult the above dose is 
given each four hours, and persevered in until the joint 
affection and febrile disturbance have completely abated ; 
it neither increases the thirst nor the furred state of the 
tongue, and its influence upon the heart is to lower its 
pulsations, but not to weaken them, and hence when 
peri and endo-carditis are present its employment is not 
contra-indicated. 

In the sub- acute forms of rheumatism the same plan 
may be employed, but in a milder form; that is, the 
doses may be smaller or fewer in number. If desired 
the citrate of potash or some other alkaline salt with a 
vegitable acid may be substituted for the bicarbonate ; 
when irritation of the intestinal canal is present the 
bicarbonate appears to act as a sedative, but when there 
is a tendency to constipation the citrate or tartrate may 
be advantageously given, care being taken that absorp- 
tion of the salt be not too much prevented by its action 
on the bowels. The potassio tartrate of iron may be 
added to the quino-alkaline draught after a time with 
much advantage. This treatment is more efficacious 
than the simple alkaline plan ; there is far less tendency 



AND GUIDE TO HEALTH. 267 

to relapse, and the patient is left in a more satisfactory 
condition. 

Treatment of heart, lung and brain complications in 
rheumatism. — Having spoken of several of the more im- 
portant methods of treating rheumatism, it is desirable 
we should inquire if any deviations are necessary when 
it attacks the heart, lungs or other internal organs. It 
has been already stated that rheumatism leads to but 
little mischief; if it does not attack the heart the joints 
rapidly recover from it. There is no such serious damage 
done them as in rheumatoid arthritis. But when it 
attacks the heart the case is very different ; for there is 
a great disposition both in the endo- cardial and peri- 
cardial serous membranes to throw out lymph, which 
may lead to the thickening of the valves and adhesion 
of the surfaces of the pericardium. It is, therefore, a 
matter of no little moment to ascertain whether any 
plan can be adopted either to prevent such mischief 
supervening or of rapidly and efficiently checking it if it 
has already taken place. There appears to be every pro- 
bability that the inflammation of the serous membranes 
of the heart is of the same kind as that of the joints, 
but it must be remembered that the structures them- 
selves are of a somewhat different character, and reme- 
dies which produce but little or no effect upon the joints 
may cause a decided action upon the cardiac tissues. It 
must not be forgotten that inflammation lingers much 
longer in the heart and is modified by the incessant 
movement of that organ. The simple application of a 
blister over the cardiac region is productive of much 
relief to the patient, and is followed by a decided im- 
provement in both the heart's movements and sounds. 

Leeches are recommended by high authority for this 
complication, but I have never used them in it. Mercury 



268 THE FAMILY PHYSICIAN 

has also been highly recommended in rhenmatism of the 
heart or the cardiac complications. "Mercury," says 
Garrod, " does not prevent the occurrence of inflamma- 
tion of the heart, and it only remains to Tbe seen whether 
this metal has any power of correcting inflammation 
after it has once ensued ; a priori, it appears scarcely 
probable that a remedy which has no influence in pre- 
venting inflammation should have the power of arresting 
it when it has already commenced." He adds: "For 
many years I was in the constant habit of administering 
calomel in cases in which inflammation of the heart was 
present ; but for the last eight or ten years I have not 
done so as frequently, and have no reason to regret the 
change of practice." 

It is claimed by the advocates of the mercurial plan 
that when they get the patient under the influence of 
mercury the violent symptoms always give way. They 
forget that it is almost impossible during the time of 
great febrile excitement to get the system under the in- 
fluence of that metal ; and how do we know but when 
this is effected that it is due to the prior abatement of 
the inflammation rather than from the influence of the 
metal. 

During the whole course of treatment of cardiac in- 
flammation, evidently the best plan for the joint affection 
is the one to be pursued, steadily and with perseverance, 
as anything which favors the abatement of the systemic 
disease must also relieve the internal complications. 

I have already stated that I believed, from all the lights 
of experience given in the way of statistics, that the 
alkaline treatment was a preventive to the cardiac com- 
plications ; and if this be so, certainly it is the proper 
plan of treatment when they are present, with the addi- 
tion, however, of the quinine and tincture of iron. 



AND CiTTIDE TO HEALTH. 269 

It is always a matter of the highest moment to insist 
upon the most complete quiet. Constant movement of 
the organ must necessarily take place, but everything 
mnst be shunned which increases this movement. All 
mental agitation and bodily exertion mnst be avoided. 
After the inflammation has snbsided the heart is gener- 
ally left in an irritable state ; to allay this a belladonna 
plaster is necessary, and the administration of small 
doses of digitalis combined with some salt of iron. 

During the high febrile excitement food can only be 
given in a liquid form, bnt it is of importance at all times 
to sustain the system as mnch as possible ; this important 
fact should be kept in view. 

Local treatment, as a general thing, is worse than use- 
less. The rheumatic liniments of the day are a grand 
humbug, and are only made to deplete the pockets of the 
ignorant. A learned professor once said that he would 
" not give one red cent for ten barrels of liniment for 
the treatment of rheumatism." Hot fomentations may 
sometimes be used to relieve pain, but even then I would 
prefer morphine or Dover's powders. 

Persons who have once suffered from this disease 
should be extremely careful to avoid any exposure 
to cold and damp, and must be careful of their dress that 
it be warm in winter, as they are very obnoxious to 
attacks on the slightest cause. Every precaution should 
be taken to avoid any sudden transition from heat to 
cold. 



270 THE FAMILY PHYSICIAN 



BHEUMATOID MYOSITIS. 

RHEUMATISM OF THE MUSCLES. 



It is an affection of the voluntary muscles, of an 
inflammatory nature (?), but unaccompanied with swell- 
ing, heat, redness or febrile disturbance. This affection 
is known to the common people by the name of rheuma- 
tism, and so treated. The medical profession even call it 
rheumatism of the muscles, and, as a general rule, give 
it the same treatment that they are in the habit of giving 
gout, rheumatoid arthritis and rheumatism. ISTo wonder 
there is so much disappointment in the treatment of the 
four different and distinct diseases termed "rheuma- 
tism." Just as well had we take the four distinct fevers, 
intermittent, remittent, typhus and typhoid, and call 
them all simply "fever" and give them all the same 
treatment, as to call and treat the four diseases above 
mentioned simply rheumatism. 

Gout, rheumatoid arthritis and rheumatism have 
already, in former articles, been described. There exists, 
however, a fourth disease belonging to the same class 
that I shall call rheumatoid myositis, which will be the 
subject of this article. I give it this name because it 
describes the condition. The disease is one affecting the 
muscles and is of an inflammatory character, hence the 
name myositis. It is also one which at least resembles 
in some respects rheumatism ; but as it can be shown 



AND GUIDE TO HEALTH. 271 

that the nature of the affection is (like rheumatoid arthri- 
tis) not the same as that of rheumatism, the prefix 
"rheumatoid," instead of "rheumatic," is sufficiently 
expressive. 

As the word typhoid is allowed for the purpose of 
designating a form of fever somewhat resembling, but 
not identical with, typhus, so no reasonable objection 
can be raised to the use of the prefix "rheumatoid," 
when it is intended to signify that the muscular inflam- 
mation, though not the same as rheumatism, yet 
resembles it in some of its characteristics. 

With regard to the history of rheumatoid myositis I 
can say nothing, for I am not aware of its ever having 
been looked upon by any pathologist as an independent 
disease, having always been described under the name 
of "rheumatism," or "muscular rheumatism," and classed 
as a variety of gout, or rheumatism, or " chronic rheum- 
atism" — a name manifestly incorrect, as the malady often 
assumes an acute character. In fact its pathology is 
different from that of any stage of rheumatism. It 
usually commences as an acute disease, but has a very 
great tendency to a chronic form ; it may affect any of 
the voluntary muscles, but is apt to attack certain sets 
rather than others. The seizures are frequently sudden ; 
sometimes, for example, a person goes to bed seemingly 
well at night and wakes in the morning and finds himself 
incapable of turning in bed or twisting the neck, and 
the attempt to do so gives exquisite pain. 

If the affection be very acute, he may suffer pain even 
when quiet, for the muscles are often thrown into a state 
of spasm ; in the less severe form the patient may be 
comparatively comfortable when at rest, but on the least 
movement he experiences great pain. On examining the 
seat of suffering no external phenomena are visible, but 



272 THE FAMILY PHYSICIAN 

there may be tenderness on exposure ; there is also a 
freedom from febrile excitement, at least at the onset of 
an attack ; but as it progresses thirst, loss of appetite 
and heat of the skin may ensue, probably due simply 
to the continuance of the pain and the loss of sleep there- 
by occasioned ; the pulse is but little affected and the 
urinary secretion preserves its normal state. A very im- 
portant feature in this disease is the absence of inflam- 
mation of the heart, so characteristic of rheumatism ; 
this never happens in rheumatoid myositis or rheumatoid 
arthritis, making a very broad distinction between either 
of them and rheumatism. In gout sometimes the heart 
is affected, but it never is in rheumatoid arthritis or the 
disease under consideration. In the acute stages the 
symptoms increase towards evening and are augmented 
by heat ; but when the disease becomes chronic the pain 
is frequently relieved by its application. The duration 
of the acute attack of rheumatoid myositis is generally 
short, usually only a very few days, seldom a week ; but 
when its intensity has become mitigated, it often proves 
tedious and may be prolonged for an indefinite period of 
time. It is also apt to be again lighted up if the patient 
be exposed to any of its exciting causes. 

Rheumatoid myositis may have its seat in the large 
masses of muscles on each side of the spine in the lum- 
bar region ; when seated there and acute it renders the 
patient utterly helpless ; the most intense agony is pro- 
duced on the slightest attempt to rise in bed or even to 
turn in any direction. When the muscles on one side of 
the neck are affected (crick in the neck) the patient is 
compelled to hold his head awry in order to relax the 
muscles. When some of the intercostal are the seat of 
the disease the symptoms are, pain in some part of the 
chest, rendered intense by the act of breathing, but re- 



AND GUIDE TO HEALTH. 273 

lieved by such pressure as prevents the movement of the 
ribs. Any of the voluntary muscles are subject to be 
attacked by the disease — the walls of the abdomen, the 
muscles of the limbs, the tongue, pharynx, diaphragm, 
are all sometimes the seat of the disease or are impli- 
cated, and even some of the voluntary muscles, as the 
stomach, intestines and uterus, appear to be susceptible 
of the disease. 

Rheumatoid myositis, although difficult to cure, is not 
attended with serious results ; there is no fear of cardiac 
inflammation, the great source of dang^ in rheumatism. 
Sometimes when it occurs in the lumbar region sciatica 
or "hip disease" arises from it, which is often both 
painful and obstinate ; but even this complication is not 
a dangerous one if treated right. But alas for the patient 
when antiphlogistic regimen is resorted to, which is the 
popular treatment! the poor sufferer gradually sinks 
under the severity of the disease and murderous treat- 
ment. 

TKEATMENT. 

The internal remedies which have been employed for 
the cure of the symptoms just described, or for the cure 
of the disease that gave rise to them, are numerous. As 
before stated, it has been looked upon as rheumatism, 
and all the long catalogue of articles that have been 
recommended for that disease have been tried time and 
again for this affection of the muscles, of course without 
advantage, and often, indeed, with great disadvantage. 

The treatment may be commenced by the use of large 
doses of acetate of ammonia, combined with bi-carbonate 
of potash, at the same time iodide of potassium in five 
grain doses should be given well diluted in water — say 
two ounces of water to live grains of the potash — three 

times a day. In cases which occur in gouty habits, col- 

18 



274 THE FAMILY PHYSICIAN 

chicum alone, or in combination with other remedies, 
may "be prescribed with much benefit. 

The time, however, soon arrives for some medicinal 
agent, as quinine, which exerts a marked action npon 
the nervous system ; and this may be advantageously 
combined with the other remedies. A happy combina- 
tion to be used in connection with the acetate of ammonia 
and the bi-carbonate of potash is the tincture of cinchona 
(Peruvian bark) two ounces, ammoniated tincture of 
guaiacum one ounce, iodide of potassium two drachms ; 
dose, two teaspoonfuls in half a tumbler of water three 
times a day. Fowler's solution has been given in ten 
drop doses, three or four times a day, in old obstinate 
cases with good effect. The bowels must be kept regular, 
and the patient well protected from cold, damp, or cur- 
rents of cold air. 

Great relief and positive benefit is often had from 
warm fomentations of bitter herbs, and also from mus- 
tard poultices placed over the painful muscle. The lini- 
ment of belladonna is also useful in relieving pain. 
Blisters are recommended, but their utility is doubtful. 
When the pain has subsided friction and electricity are 
often resorted to in order to diminish the stiffness and to 
restore tone and activity to the muscles. 

The diet must be generous, with a moderate amount 
of stimulants, either wine, brandy, good bourbon or rye 
whisky, or malt liquors. Unlike gout, any of these are 
admissible, and in fact highly useful in the chronic form. 
The spirit vapor bath may be occasionally used with 
caution, if the patient is not much debilitated; if, however, 
he is, a sponge bath with warm alkaline water must be 
used, in which case the patient must be speedily wiped 
dry with considerable friction, getting up a glow of the 
skin if possible. 



AND GUIDE TO HEALTH. 275 

The capillary circulation is always deficient in rheu- 
matoid myositis, while sweating is a characteristic of 
rheumatism ; for this reason guaiacum is an excellent, 
if indeed not an indispensable, article in the treatment of 
rhumatoid myositis, while it is positively injurious in 
rheumatism : still in almost every work we find it recom- 
mended for rheumatism. Colchicum, also, is almost a 
specific for gout, while it may do great damage in rheu- 
matism. Hence you can easily see the necessity for the 
diseases to be kept separate and distinct, as they belong.. 

The patient should be warmly clad in flannel, and 
every precaution taken to avoid chills, or the application 
of cold or dampness. Care should be taken not to exer- 
cise the affected muscles too much ; rest will facilitate 
the cure. 



276 THE FAMILY PHYSICIAN 



GONORRHEAL RHEUMATISM. 



The affection which is known as gonorrheal rheuma- 
tism consists of inflammation of and about the joints, 
following upon urethral discharge. 

The disease is one that I have never met with, and 
I have been skeptical about its existence ; but when the 
disease is mentioned by such authorities as Sir Astley 
Cooper, Sir Benjamin Brodie, and Bernard Edward 
Bradhurst, I can but accept it as a fact. From Dr. Brad- 
hurst's article on it I will make a few extracts, for he is 
excellent authority. In an article of considerable length 
on this disease he says : " Gonorrhea, then, being estab- 
lished, one or more joints become, in the course of ten 
days to three weeks, stiff, painful and swollen, the 
patient having perhaps exposed himself to the weather, 
sitting or walking in wet clothes, or to a draught of cold 
air. At the same time the feet may be painful and the 
conjunctiva inflamed ; there will be considerable fever, 
with dry skin and a furred tongue. Probably, as the 
articular inflammation increases, the urethral discharge 
will diminish, again it will become more abundant, and 
at length cease or degenerate into a gleet. The first at- 
tack of gonorrheal rheumatism is invariably preceded by 
a specific gonorrheal discharge ; a subsequent attack 
may be preceded by urethral discharge which is not of a 
specific character ; and also the same character of articu- 
lar disease may be re-excited without the urethral dis- 



AND GUIDE TO HEALTH. 277 

charge being developed. * * * * The joint 
having become inflamed, a large effusion of serum takes 
place into the synovial cavity ; but although there may 
be great tension, suppuration never occurs." 

After giving a few cases of various grades and interest 
Dr. Bradhurst gives the following remarkable case : 
"After several attacks of gonorrheal rheumatism the 
disease was again set up without urethral discharge 
appearing. A gentleman, twenty-five years of age, 
acquired gonorrhea, which was soon followed by pain 
and swelling of the knees. The urethral discharge 
appeared on the seventh day, and some few days later 
synovities supervened with great effusion into the knee 
joints. The skin was hot and dry, and he suffered 
acutely, so that he had difficulty in making the least 
movement. The urethral discharge continued for two 
months, and then ceased altogether; and the swelling 
and stiffness of the knee also at length entirely disap- 
peared — having lasted three months. After another 
interval of three months this individual was again 
affected with gonorrhea. The urethral discharge again 
appeared on the seventh day and continued for two 
months. After some few days the left hip joint became 
inflamed, as well as the ankle and tarsal joint. The soles 
of the feet were not affected. This attack was of a much 
more severe character than the former one — the effusion 
was greater and the pain more acute. After ten months 
my patient was able to walk with sticks. Stiffness and 
a painful condition of the limbs continued yet, however, 
for many months ; but at length he regained the use of 
his limbs. After a lapse of several months he again 
contracted the gonorrhea. On this occasion the symp- 
toms resembled closely those already recorded as occur- 
ring on former occasions ; but he never entirely recov- 



278 THE FAMILY PHYSICIAN 

ered from the stiffness which resulted from this attack of 
articular inflammation. Now both hips, both ankles 
and one knee became inflamed ; he also suffered from 
ophthalmia. Ankylosis did not occur, but there were 
certain of the joints which prevented him from rising 
after he had been seated for some hours. About six 
months after he was able to walk about he married. 
Painful attempts were made to consummate the mar- 
riage, but it was found to be impossible. At this 
time — namely, within a very short period of marriage — 
articular inflammation recurred. On this occasion, how- 
ever, there was no urethral discharge whatever. The 
articular inflammation proceeded, and, at length, pro- 
duced ankylosis of every joint in succession ; so that in 
five years the whole skeleton was implicated ; the atlas 
was ankylosed with the axis, and, in consequence, the 
head could not be moved; and all the vertebrae were 
ankylosed together, and the hips, knees, ankles, shoul- 
ders, elbows, wrists and jaw were so firmly fixed that no 
movement whatever could be obtained." 

TREATMENT. 

For the treatment of this disease the doctor recom- 
mends purgatives freely and a little blood from the arm, 
with Dover's powders freely at night. He also recom- 
mends the Turkish bath. In the chronic stage he recom- 
mends thirty or forty grains of iodide of potassium daily 
and light diet ; also, gutta percha splints to the affected 
j oint to prevent motion. In addition, I would recommend 
tonics plentifully given, or bark and a more generous 
diet, and later alcoholic stimulants. 



AND GUIDE TO HEALTH. 279 



VACCINATION. 



Vaccination or vaccine inoculation is the process by 
which a peculiar specific disease — vaccinia or the cow- 
pox — is introduced into the human system with a view 
of protecting it against an attack of small-pox. 

About the year 1768 Edward Jenner, an apprentice to 
a surgeon at Saulsbury, near Bristol, was impressed with 
the belief that milkers who had been infected with a dis- 
ease known as cow-pox were not susceptible to small-pox. 
At a very early period of his medical career, which was 
a very brilliant one, he set himself to investigate the 
truth of the matter, and in the course of inquiries and 
reflections which satisfied him on this point, his genius 
conceived the idea that it might be possible to propagate 
the cow-pox at will in man, first by directly inoculating 
it from the cow and then from one human subject to an- 
other, and that thereby protection against small-pox 
might be imparted in perpetuity. 

It is in this transmission of vaccinia from one human 
subject to another that the practical usefulness of Dr. Jen- 
ner's discovery lies ; and since he first properly made the 
process known all ordinary vaccinations have been carried 
on in this way. Lymph has since that time occasionally 
been obtained direct from the cow ; but the great bulk 
of the vaccinations of the present day, in Europe and 
America at least, are performed with lymph transmitted 
from the early direct vaccinations of Jenner himself. 



280 THE FAMILY PHYSICIAN 

This discovery of Dr. Jenner, put into practice about 
the year 1798, justly stands acknowledged one of the 
greatest in the science of medicine, and has done more, 
perhaps, to prevent suffering and premature death than 
any other discovery ever made. It protects almost uni- 
versally against small-pox, and the few cases that are 
susceptible to it are almost universally so light that "but 
little importance can be attached to them ; in fact it 
almost completely disarms a disease at once the most 
terrible, the most loathsome and the most dangerous of 
all its terrors. 

Persons who have once been successfully vaccinated 
are, as a rule, permanently protected against small-pox. 
A certain but indeterminable proportion of vaccinated 
persons will, however, be liable at some time or other of 
their lives, especially under epidemic influence, to take 
small-pox in a mild and modified form. A very much 
smaller proportion will be liable to take it in a severe, 
disfiguring, and even fatal form. But the liability of any 
individual to take small-pox severely after vaccination, 
and probably the liability to take it at all, will be 
inversely as the goodness and amount of the vaccination. 
Children should all be vaccinated, but except for press- 
ing reasons they should only be vaccinated when they 
are in good health. Especially they must be free from 
any acute disease, from diarrhea or from any skin 
disease, such as herpes, &c. There are circumstances 
of risk, however, as when the infection of small-pox 
is near at hand, which render it imperative to perform 
vaccination, notwithstanding this contra-indication. As 
a rule it is always best to vaccinate children when 
they are from three to six months old; at three it is 
preferable, as at that early period they are free from 
the disturbing element of teething. Under circum- 



AND GUIDE TO HEALTH. 283 

stances, however, of direct exposure to small-pox it 
should be well understood that no age is too early for 
vaccination ; infants have been repeatedly vaccinated im- 
mediately after birth and thereby saved. In all cases of 
much risk it is of the utmost importance to avoid delay. 
The loss of a single day may be the loss of a precious 
life. Vaccination may be in time to prevent small-pox 
altogether ; but even supposing the variolous poison to 
have been imbibed before the vaccination has been per- 
formed, still if the vaccination be only got to the stage 
of areola before the small-pox manifests itself, it will 
exert its modifying power and the child will be saved. 
The time required for small-pox to develop or the time 
for incubation is twelve days, and the time required for 
vaccination to be carried to areola being only nine days, it 
is manifest that even a person who has imbibed the 
infection of small-pox may, by being vaccinated within 
the first three days after the reception of the infection, 
obtain the modifying effects of vaccination. A day 
more and the vaccination will be too late to do any good. 
The lymph to be used in vaccinating must be taken 
from healthy subjects and from thoroughly characteristic 
vesicles. Much has been written on this subject, and I 
believe up to about 1861 the profession had, as a general 
thing, come to the conclusion that it was not really of 
great importance whether the subject from whom the 
lymph was taken was really very healthy or not ; even 
the profession had almost come to the erroneous conclu- 
sion that there was no danger in using the lymph out of 
the arm of a person diseased with syphilis (pox). This 
security, however, was broken by a very circumstantial 
account of a singular outbreak of epidemic syphilis at 
Rivalta, in 1861, traceable it was said to a vaccinal origin, 
and by one or two cases — especially by one which 



282 THE FAMILY PHYSICIAN 

occurred in the wards of M. Trousseau, at the Hotel 
Dieu, in Paris, in 1861 — which afforded, it was alleged, 
direct proof of vaccino- syphilitic inoculation. 

It is a little strange that from vaccination with 
syphilitic matter and vaccine lymph, both at the^ same 
time and in the same place, syphilis and not vaccina would 
result, but we know that this would be the case from a 
great number of experiments. Then the question very 
naturally arises, How then can a person by being vacci- 
nated from the arm of a syphilitic individual have both 
vaccina and syphilis developed ? "We do not have very 
far to seek for a solution of this problem. In syphilitic 
disease the blood is poisoned by the absorption of 
syphilitic virus. The communication takes place through 
the blood ; the lymph and syphilitic blood being inocu- 
lated together, each within its own period of incubation 
will produce its own specific results. The vaccina disease 
will first run its course, or nearly so. The effects of the 
blood inoculation will manifest its own specific results. 
Hence it will be seen that it is by inoculating with the 
blood of the syphilitic person as well as the vaccine 
lymph that syphilis is conveyed after the vaccine. 
This fact can not be too well impressed upon the mind : 
Never vaccinate with any lymph (or matter) that has one 
particle of blood in it. It is sometimes the case that the 
lymph in the arm of a syphilitic person will present a 
reddish appearance, or, in other words, there will be blood 
enough in it to cause it to look as if a little brick dust 
had been mixed with it. To vaccinate with such lymph 
as that would, in at least two cases out of three, produce 
syphilis. 

We are told in medical works of numerous experiments 
where persons have been vaccinated from the arms of 
those who were known to have syphilis, and with no bad 



AND GUIDE TO HEALTH. 283 

results, L e., the syphilis not being conveyed. No men- 
tion is made of the color of the lymph. M. Trousseau's 
case was that of a yonng woman who was vaccinated 
from a child. It was not really known whether the child 
was diseased or not, and nothing is stated as regards the 
color of the lymph, or whether care had been taken not 
to have any blood in it. The young woman, however, 
had two undoubted syphilitic sores on her arm one 
month afterward. 

The occurrence at Bivalton was, forty- six children 
were vaccinated from the arm of a child incubating 
syphilis, and on the tenth day afterward seventeen other 
children were vaccinated from the arm of one of the 
.forty- six, making in all sixty-three. Of these sixty 
three forty-six had syphilis within two months. 

In 1865 one person of a family living near Sumner, 
Kansas, was vaccinated, and at a proper time two others 
of the family were vaccinated from his arm. Soon, how- 
ever, syphilitic sores appeared, and others were vaccinated 
from them, among whom was a healthy child, who after- 
ward came to Franklin county, Missouri, where quite a 
number were vaccinated from its arm. About two-thirds 
of all who were vaccinated with that lymph had unmis- 
takable syphilitic sores, many of whom I saw myself; the 
lymph presented that bloody or brick- dust color. Two of 
the family who were first vaccinated near Sumner, Kansas, 
are still suffering from the disease ; their constitutions 
are seriously injured, and one of their arms is made 
useless by the terrible disease. One of them is a young 
lady. Her mouth has healed up twice so it had to 
be operated upon, and now it will only admit of the 
introduction of the end of a finger. She is much dis- 
figured, and has been rendered a cripple for life. Her 
agony has been great, and she still suffers the most ex- 



284 THE FAMILY PHYSICIAN 

cruciating pain. They have spent five or six thousand 
dollars with medical men, and are still pitiable objects. 
I call attention to these lamentable cases that others 
may take warning, and use greater care in the selection 
and introduction of the "matter" they use for vaccina- 
tion. 

Dr. E. C. Seaton, after discussing the negative of this 
blood theory at great length, says : " But while the com- 
munication of syphilis in vaccinating, through the care- 
less inoculation of blood, must not be accepted as 
proved, it behooves the practitioner, bearing in mind the 
duty of avoiding every possible risk, to be more than 
ever careful to vaccinate only from the healthiest child- 
ren, from the most perfect vesicles at the proper period 
of their course, and with pure, unmixed vaccine lymph, 
free from the slightest stain of oloodP 

A healthy child should thus be selected, and one, of 
course, with its first vaccination, as second or re-vaccin- 
ation only produces spurious lymph in a majority of 
cases. The regular phenomenon of vaccination can only 
be produced once in the lifetime, so that if a person has 
been once vaccinated, and it " takes," as the saying is, 
it is folly, or worse than folly, to re-vaccinate, because 
the first vaccination will afford all the protection against 
small-pox that forty vaccinations would ; and it is always 
attended with some danger to re-vaccinate, the lymph 
acting as an animal poison and giving rise sometimes to 
dangerous symptoms, and in a few cases on record even 
to death. 

The vesicle is best suited to vaccinate from about the 
eighth day after it has been introduced into the child's 
arm, or, in other words, the day week after vaccination ; 
the vesicle is then generally well formed, and that is the 



A^D GUIDE TO HEALTH. 285 

proper time for vaccination. It is a great mistake to 
wait until it is old. 

A healthy child being selected, and a vesicle fit for 
use. yon can proceed to open it by a number of minute 
punctures, which must be carefully made on its surface, 
and not around the base. The object of many punctures 
is to open the various cells of the vesicle, and the reason 
for making these on the surface and not around the base 
is to obtain the lymph free from any admixture of blood. 
If by accident any blood be drawn, it must be allowed to 
coagulate and then be carefully removed before taking 
the lymph ; for it is a cardinal rule, never to be deviated 
from, that the inoculation must be with vaccine lymph, 
and with lymph only. 

When the cells of the vesicle are freely opened the 
lymph soon exudes and lies on the surface. A clean 
lancet may then be well charged with this lymph, and 
the operator may grasp the bare arm of the child with 
the left hand so as to put the skin on the stretch, the 
point of the lancet thus well charged with lymph may be 
inserted into the cutis ; the lancet should not be held on 
a level with the arm, but at an angle of about 45 degrees. 
If the lymph thus well put in is retained by the valvu- 
lar character of the puncture and the elasticity of the 
skin, any fear that the bleeding which ensues will cause 
the vaccination to fail is groundless. A minute and 
superficial puncture on the hand does frequently fail. 
About five of these punctures should always be made, 
never less, and if there is not room enough on one arm 
make one or two on the other. 

Various other modes have been practiced, such as 
scarifying and then spreading the lymph over the scari- 
fied surface ; also, by making a lot of cross scratches, 



286 THE FAMILY PHYSICIAN 

etc., etc. None of them, however, I think, are as suc- 
cessful or as simple as the one recommended above. 

Now, the few points to be recollected are, 1st. To vac- 
cinate all children from the third to the sixth month. 2d. 
To vaccinate from the arm of a healthy child as soon as 
the vesicle will do, or about the eighth day. 3d. Never 
allow any blood, or stain of blood, to be in the lymph. 
4th. Be sure to introduce it well in at least five places, 
so that it may be certain to "take." 5th. Never re-vaccin- 
ate when you are sure the first vaccination " took well," 
which may be ascertained by looking for a few well 
marked pox or cicatrices. 



AND GUIDE TO HEALTH. 287 



SMALL P0X-YAR10LA. 

(German— BE ATTETiX. FrencJi— PETITE VERQLE.) 



Small pox is a febrile, eruptive and infectious disease, 
the product of a morbid poison, which, after a period of 
latency, causes the development of an eruption on the 
surface of the body ; this passes through the stages of 
pimple, vesicle, pustule and scab, and, as a rule, exhausts 
or destroys the susceptibility to the disease in the same 
person for the remainder of life. 

The early history of small pox seems to be wrapped 
in much obscurity ; there is nothing in history that 
would indicate that it was known at all to the Greeks 
and Eomans. The earliest history we have is from Pro- 
copius, who lived about the middle of the sixth century. 
In the year 569, the year that Mahomet was born, it 
broke out in the Abyssinian army, under Abrahab, the 
Viceroy of Egypt, before Mecca, and caused a sudden 
retreat. Its mortality was very great, destroying a great 
number of that fine army. Rhazes, an Arabian physi- 
cian, who flourished about the year 900, wrote extensively 
on small pox, and in his writings referred to others who 
had written about it, especially to Ahron of Alexandria, 
and Messue of Bagdad. 

Tradition says small pox in man had its origin in the 
camel. If we reason from analogy, the tradition is not 
correct, inasmuch as all other diseases that have been 



288 THE FAMILY PHYSICIAN 

conveyed to man from the lower animals are not com- 
municable by infection, only by "inoculation. When 
once produced in man they are still not infectious, in the 
usual acceptation of the term, as small-pox is ; only pro- 
duceable again from one to another by inoculation, as 
in the instances of cow-pox, glanders, hydrophobia, &c. 
Small pox appeared in England in 1847, in the sheep, 
as appears from a work by Prof. Simmons, veterinary 
surgeon in the Royal College, London. 

SYMPTOMS AND DESCRIPTION. 

It is called discrete when the pustules stand sepa- 
rately; semi-confluent when they partially coalesce; 
confluent when they join and run into each other; 
corymbose when the disease appears in patches ; malig- 
nant when the eruption, besides being generally con- 
fluent, and the initiatory symptoms are very severe, with 
hemorrhage from the mucous surfaces, patches of pur- 
pura, and discolorations of the skin, as if having been 
bruised ; benign when — although perhaps confluent — the 
eruption is superficial and the accompanying symptoms 
are of a mild character ; anomalous when the disease is 
complicated with other diseases, eruptive or otherwise, 
as measles, scarlatina, pneumonia, whooping-cough, 
bronchitis, disease of the brain, &c. 

Small-pox is divided into four stages— first, the stage of 
incubation, which lasts twelve days from the day of 
receiving the variolous germ or the contagion ; second, 
the stage of initiatory or eruptive fever or invasion, 
lasting forty-eight hours ; third, the stage of maturation, 
continuing about nine days ; fourth, the stage of second- 
ary fever, desiccation and decline, lasting, of course, an 
uncertain time, varying according to the severity of the 
disease. 



AND GUIDE TO HEALTH. 289 

Stage of incubation. — Small pox appears on the skin 
on the fourteenth day after the infection of the disease 
has been received into the constitution — the precise time 
being after thirteen times twenty-four hours have elapsed 
from the moment of taking the disease. This time will, 
of course, occupy twelve whole days and part of two 
others. 

Stage of primary fever. — After twelve days' freedom 
from illness after the disease has been contracted there is 
severe indisposition for forty-eight hours, and then the 
eruption of small-pox begins to appear. The eruption 
appears first usually on the face, forehead and wrists, and 
then on the rest of the body; it is generally a couple of clays 
later on the legs and feet than elsewhere. The eruption 
is at first papular, then vesicular, then pustular, and takes 
about eight days to arrive at its full development before 
the pustules begin to discharge their contents. During 
this stage the face and eyelids often swell and there is 
ptyalism (salivation), and the skin is remarkably tender. 

Stage of secondary fever ', desiccation and decline. — 
When small-pox is not of such severity as to destroy life 
by the eighth or ninth day of the eruption, there is a 
great increase of fever again, called the secondary fever, 
which is of vast importance and gives rise to a train of 
severe and complicated symptoms ; concurrently with it 
the pustules discharge their contents and form dry, scaly 
scabs, and in favorable cases the disease begins to decline. 

The first symptoms observed are rigors, fever, thirst, 
headache, sickness at the stomach, sometimes accompa- 
nied with vomiting, pain in the back and general indis- 
position, followed after forty-eight hours of this illness 
by an eruption on the skin of pimples, which are, as 
before stated, on the face. On pressing the fingers over 

the points of eruption some hardness is felt in the skin, 
19 



290 THE FAMILY PHYSICIAN 

as if a grain of mustard was imbedded in it, but the skin 
is not tender at these points, nor does pressure seem to 
produce any pain. 

In cases of small-pox after vaccination the true or 
distinctive eruption of small-pox is often preceded by 
roseola, which lasts two or three days, resembling very 
much scarlet fever ; but this eruption may be known from 
scarlatina by not being so completely diffused over the 
skin as the rash of scarlatina usually is ; it is also of a 
lighter, brighter scarlet tint. 

Secondary fever. — Besides the initiatory fever of inva- 
sion in small-pox there is what is called the secondary 
fever, which begins, in confluent cases, about the eighth 
or ninth day. In milder cases of small-pox secondary 
fever is hardly perceptible ; in the malignant and severely 
confluent cases death takes place before the secondary 
fever has barely commenced. But in most instances of 
confluent small-pox patients suffer more or less from 
secondary fever, which seems to be the cause or forerun- 
ner of a very important chain of events. The pulse is 
increased in frequency, there is thirst, dry tongue and 
hot skin ; in many cases, particularly the plethoric, some 
local inflammation or exudations arise, it would seem 
either from slight injuries at the time or old hurts received 
many months ago ; often there are numerous small boils. 

Pleurisy is one of the most painful and fatal sequelae 
of secondary fever of confluent small-pox ; it generally 
terminates fatally in three or four days. Pneumonia, 
bronchitis, glossitis, olitis or erysipelas may either occur, 
but none are as fatal as pleurisy ; still some patients who 
have pleurisy recover. 

Variolous ophthalmia and corneal ulcerations, con- 
junctival inflammation, often begin on the fifth or sixth 
day in small-pox, continue a few days and then sub- 



AND GUIDE TO HEALTH. 291 

side under the use of simple remedies. But there is 
another form of mischief more serious — ulceration of the 
cornea — which often leads to the loss of an eye, both 
eyes being rarely affected, although this does sometimes 
happen. I have in my mind at this time a melancholy 
case that occurred a few years ago in Sedalia, Mo., where 
a lovely and estimable young lady lost both eyes from 
this cause. The injury to the eye by which the organ is 
destroyed is not from the pustules of small-pox forming 
on the eye, as used to be supposed, but from a destruc- 
tive form of ulceration beginning almost invariably at 
the edge of the cornea. These cases are of very rare 
occurrence. The ulceration of the cornea that leads to 
the destruction of the eye in small-pox begins after the 
secondary fever has commenced. The fourteenth day is 
the common time for it to be first seen. It comes on 
with a redness and slight pain in the part affected, and 
very soon an ulcer is formed, having its seat at the margin 
of the cornea almost invariably. This spreads with more 
or less rapidity, according to the secondary fever. In the 
more violent cases the ulceration commences on each 
side of the cornea. 

SUSCEPTIBILITY TO SMALL POX. 

Each individual of the human species is born, it would 
seem, with a susceptibility to contract small pox, measles, 
scarlatina, and perhaps some other diseases belonging 
to what is called the zymotic class — those diseases which 
are produced by a morbid animal poison. There is in the 
organism, most likely in the blood, some inborn principle 
or ingredient, clearly not essential to life and well being,, 
by which we are rendered liable to undergo these diseases.. 

Infectious nature of small pox. — All doubts have long 
since been dispelled of the infectious nature of small 



292 THE FAMILY PHYSICIAN 

pox. It is communicable from the very first moment 
when the initiatory fever begins. It may be given by 
the breath of the patient before the eruption has ap- 
peared on the body. It continues infectious so long as 
any of the dry scabs resulting from the original erup- 
tion remain adherent to the body ; a single breathing of 
the air where it is is enough to give the disease. The 
dead body for several days after death has been known 
to give the disease. Clothes will retain the infection for 
a long time unless they are thoroughly washed and 
exposed to the air. 

TREATMENT. 

" Titer e is no specific for the cure of small pox." Dr. 
Gregory says : "It is a melancholy reflection, but too 
true, that for many hundred years the efforts- of physi- 
cians were rather exerted to thwart nature and to add 
to the malignancy of the disease than to aid her in her 
efforts. Blisters, heating, alexipharmies, large bleed- 
ings, opiates, ointments, masks and lotions to prevent 
pitting, were the great measures formerly pursued, not 
one of which can be recommended." 

One of the first things to be done is to place the pa- 
tient in a large, airy room, which must be kept cool in 
summer, and in winter at an agreeable temperature. 
Formerly patients with small pox were kept as warm as 
possible ; great heaps of bed clothes were piled about 
them — a horrible practice — all fresh air was shut out 
from them, and they were forbid any ablutions, or even 
change of clothes or bed clothes. We now use light bed 
clothes, frequent change of linen, fresh air and ablutions, 
and cooling drinks, with the greatest benefit to the 
patient. 

In a great many cases it will not be known for the first 



AND GUIDE TO HEALTH. 293 

two or three days of small pox what febrile ailment is 
approaching ; and even if it were known the mode of 
treatment would not materially differ. It will be right 
to give a dose of opening medicine to relieve the bowels, 
to keep the patient on simple diet, and to give saline 
medicines, such as the citrate of potash or tartrate of 
soda, in a state of effervescence. 

In confluent cases of small pox it is necessary to cnt 
the hair close ; in the nnvaccinated, especially in chil- 
dren, the sooner the better. But in the vaccinated ex- 
ceptions may be made, to females especially — it is a great 
mortification to lose a fine head of hair; bnt if after 
waiting nntil the fifth or sixth day the disease is not 
modified, the hair then must be cnt. 

The diet of the patient should consist of tea and toast, 
without butter, bread and milk, milk and mush, rice, 
oatmeal gruel and baked potatoes. He should also have 
grapes, orange juice, strawberries, or apples roasted. 
For drinks he may use lemonade, toast water, imperial 
drink, apple water, tamarind water, or, what is more pre- 
ferable, plain water, good and cool. Cordials are used by 
some under the rash notion of propelling the pustules 
toward the skin ; this course is injurious and should 
never be allowed. 

If delirium sets in in confluent small pox, as it some- 
times does, in both plethoric and those of a weakly con- 
stitution, the plethoric patient should take a cathartic of 
citratized magnesia, while the weakly patient should 
take stimulants — either good Port, Clinton, or Norton's 
Virginia Seedling wine. Great care must be taken in 
discriminating between the plethoric and weak in giving 
the stimulant. 

In the plethoric the first opening of the bowels may be 
by giving six or eight grains of calomel and as many 



294 THE FAMILY PHYSICIAN 

of rhubarb, with the addition of salts and senna in eight 
or ten hours if it do not operate. Two or three operations 
of the bowels may be produced daily for two or three 
days, but in the weakly salts and senna or the citratized 
magnesia is enough to commence with; and if after- 
ward, through the course of the disease, the patient has 
one passage daily without medicine it is so much the 
better, but if the bowels do not move and the tongue is 
foul, salts and senna must be used to open the bowels 
once a day. Sometimes it happens that the bowels are 
too much relaxed ; when this is the case the chalk mix- 
ture, with a teaspoonful of laudanum added to two ounces 
of it, must be given in tablespoonful doses to keep them 
checked sufficiently. If this preparation fail to stop the 
diarrhea, give a few grains, say four or five, of gum kino 
with each dose of the chalk mixture and laudanum. 

If in the commencement of the attack the patient is 
restless and can not sleep at night, a dose or two of 
morphine may be tried, and repeated if it seems to do 
good, though very often it fails to do good, in which case 
it must be stopped. But it often happens that late in the 
disease the patient is restless and can not sleep ; it is then 
that morphine will do good and must be given. Put 
four grains of morphine in an ounce of water and give 
from twenty to thirty drops at a dose. 

Very soon after the secondary fever sets in the system 
will begin to require some additional support ; beef tea 
or calves' feet jelly must be added to their diet, and 
wine becomes necessary. If the appetite is poor and 
great weakness is complained of, a grain or two of 
quinine with three or four drops of elixir of vitriol must 
be taken three or four times a day, and when the appe- 
tite begins to improve a little well boiled meat may be 
taken. Game, poultry and light boiled eggs may be 



AND GUIDE TO HEALTH. 295 

allowed, and in cases of great prostration brandy mnst 
be given. 

Things in tlie unvaccinated do not always go on so 
smoothly as this ; some large collections of matter may 
form, with sloughing of the cellular membrane, requiring 
to be opened, or numerous boils harass the patient. It 
often happens that matter is formed under the scalp, 
small in amount at first, but it goes on collecting and 
spreading, and there is no disposion to point and break 
in this part as in other parts of the body. These collec- 
tions should be opened early to prevent their spreading ; 
the operation is rather painful, from the thickness of the 
scalp. A simple incision does not answer well, and Dr. 
J. F. Marston, who has had perhaps as great experience 
in the treatment of small pox as any man now living, 
recommends a seton to be passed through the abscess so 
that the matter may keep constantly draining away. 
Those cavities are often tedious to heal, and will require 
a little touching with nitrate of silver to aid them in this 
process. During convalescence quinine and tincture of 
iron should be used. The discharge from the pustules 
in some confluent cases is considerable and acrid ; the 
itching and discomfort produced by it on the skin are 
relieved by the application of flour or starch applied by 
means of a common dredging box dusted on the face 
and hands and inside of the shirt and sheets. 

Many patients have numerous boils resulting from 
small pox. When this is the case a decoction of Peru- 
vian bark or quinine and elixir of vitriol must be used, 
the vitriol in eight or ten drop doses in half a glass of 
water. 

Some patients like cold, others like warm applications 
in erysipelas ; some feel better with flour dredged over 
the inflamed part. If one plan does not feel comfortable 



296 THE FAMILY PHYSICIAN 

another should be tried. A liberal supply of wine shonld 
be allowed, the same as in gangrene. Both erysipelas and 
gangrene are generally preceded by bilious vomiting and 
very often by diarrhea. During the sloughing of gan- 
grene, at its commencement, nitric acid lotion, a drachm 
to a pint of water, may be used with benefit ; later some 
antiseptic should be applied ; a poultice of finely pow- 
dered charcoal and linseed meal may be applied. When 
there is any discharge from the genital organs, either 
male or female, they must be cleansed at least twice a 
day ; if they are neglected gangrene is very likely to 
occur. This unpleasant office must be performed by the 
nurse, as the patient is not able to do it. It must not in 
anywise be neglected; the most serious consequences 
will occur if it is. 

Pleurisy is one of the most dangerous complications 
that can arise in the advanced stage of small pox. About 
the only plan we can adopt in this emergency that would 
promise success would be to put a large blister on the 
affected side and give a full dose of morphine, which 
may be repeated in six hours if the pain has not much 
subsided. 

Pneumonia is also a serious complication when it arises 
in the advanced stage of small pox, and does not admit 
of active treatment. A blister should be applied, and 
five grains of blue mass given at night for two or three 
nights, acetate of ammonia at intervals, a full dose of 
Dover's powders night and morning, and beef tea as a 
diet. 

Bronchitis is another of the dangerous inflammations 
occasionally met with in advanced stages of small pox, 
which will not admit of much more than palliative treat- 
ment. A blister and opiates are all that had better be 
attempted, with good diet of beef tea. 



AND GUIDE TO HEALTH. 297 

Variolous ophthalmia and ulceration of the cornea are 
amongst the most serious results of continent small pox. 
The patient must be pnt upon as generous a diet as can 
be borne, and allowed of wine three or four glasses a day, 
with tincture of Peruvian bark freely. The ulcer on the 
cornea must be touched with a strong solution of nitrate 
of silver (twenty grains to the ounce of rain water) ; as 
soon as this is done a drop of fine sweet oil should be 
dropped into the eye. This operation should be per- 
formed every day. 

If the conjunctiva (white of the eye) becomes inflamed, 
as it sometimes does, and an ulcer after a few days is 
found on it, a weak solution of nitrate of silver (two or 
three grains to the ounce) may be dropped into it two or 
three times every other day. 

One thing more only I will notice in the management 
of small pox. From the earliest periods in the history 
of small pox strenuous efforts have been made to pre- 
vent the "pitting" that takes place from this disease. 
It must be confessed that it sometimes disfigures the 
countenance terribly, and gives to the most handsome 
face a very common expression. We need not wonder, 
then, at the anxiety of friends, as well as of the patients 
themselves, that something should be done to prevent, 
as far as possible, future disfigurement. Some good can 
be effected, but when the disease is very severe the mis- 
chief arising from this cause can not be wholly avoided. 
Yelpeau recommended, some years since, that each 
vesicle should be opened and cauterized with a stick of 

I nitrate of silver. This must be done the third or fourth 
day. This might do in a mild case, but in a bad conflu- 
ent one which is calculated to do great "pitting" it would 
not be at all practicable. Yarious other modes have 



298 THE FAMILY PHYSICIAN 

Marston, whose practice lias been so extensive and so 
successful, says : " What we do generally is this : wait 
until the pustules have discharged and the discharge has 
begun to dry, then put on some of the best olive oil, or a 
mixture of one-third glycerine and two-thirds rose water. 
Some of this may be applied once or twice a day for a 
few days, until the scabs begin to loosen. Cold cream 
and oxide of zinc, or olive oil and lime water, form good 
applications ; or, if the discharge is thin and excoriating, 
calamine mixed with olive oil. The patient should be 
warned not to allow the scabs to dry and remain some- 
time on the nose and other parts of the face, particularly 
on the forehead and near the end of the nose ; when this 
takes place the dry scabs themselves leave deep marks 
in the skin worse than the eruption of small pox itself. 
The pain of removing the dry scab is sometimes con- 
siderable, and the patient can hardly be prevailed on to 
take them off, or allow others to do so." If this course 
is pursued the " pitting " will be very trifling, the result 
amply rewarding the pains. 



a:ctd guide to health. 299 



SCARLET FEVER-SCARLATINA. 



Scarlet fever is an acute specific disease caused by 
contagion, and contagion only. The earliest record we 
have of it is in 1556, the year in which Ph. Ingrassias 
published a description of it. It had, however, been 
previously recognized by the common people and called 
Rossalia. In 1676 appeared Sydenham's short chapter on 
"Febris Scarlatina." 

In degree of contagiousness scarlet fever takes a place 
between measles and whooping-cough above, and ty- 
phus fever below — diphtheria being very far below. 
The contagious principle may be taken up by clothes, 
and retained by them for a great length of time ; thus a 
strip of flannel is said to remain contagious for a year ; 
so says Watson. Hilderbrand was infected by a cloak 
which, after exposure to the case, had been put aside for 
eighteen months. Hence we may assume that the mor- 
bific principle of scarlet fever is any thing but volatile 
or unstable, which being so affords an answer to the 
important question : "When does a person who has re- 
covered from an attack of the disease cease to be conta- 
gious ? To speak strictly, not until those natural fomites, 
the epithelial scales, which were existing at the time of 
the fever, have been removed, or, what is nearly the 
same, not until disquamation has ceased; and in the 
fact that, under ordinary circumstances, those epithelial 
scales are all but permanently contagious. Uncovering a 



300 THE FAMILY PHYSICIAN 

scarlet fever patient in the direct rays of the snn, a 
clond of fine dnst may he seen to rise from the body — 
contagions dnst which, no donbt, subsides into every 
crevice near the bed. The distance at which the disease 
may be communicated is commonly said to be not more 
than a few feet ; yet, considering the slight volatility of 
the poison, one is quite prepared to admit the possibility 
of what is said to' have occurred, namely, of the conta- 
gion having been conveyed hundreds of miles by letter 
or similar means. 

A person who has passed through one attack of the 
disease is not so apt to contract it again. Still the pos- 
sibility of recurrence and relapse is admitted on all 
hands. Scarlet fever appears at any season, but in this 
country the spring or fall is generally the time it is most 
prevalent. 

The period of incubation is in all probability less than 
a week, and sometimes it may occur in twenty-four 
hours ; it may sometimes, however, last more than a 
week. Like all other contagious diseases it varies, and 
we may put this variation at from twenty -four hours to 
ten days. 

SYMPTOMS. 

Scarlet fever is sometimes very mild, so much so as 
almost to escape the notice of either the physician or 
patient ; and again it is so severe as to kill inevitably 
in twelve hours. Between these extremes lies a mean or 
typical form in which all the characteristic symptoms 
are well developed. Of this form we will proceed to 
speak. The first symptom noticed, particularly in adults, 
is sore throat, a tenderness at the angles of the lower 
jaw, and stiff neck soon follows. The onset, except in 
mild cases, is sudden ; it is often easy to fix the hour 
and almost the very minute at which the disease begins. 



AXD (IUIDE TO HEALTH. 301 

Vomiting is the warning that children generally give ; 
but not so with adults. It may be repeated many times, 
becoming ultimately bilious. The first febrile symp- 
toms is often, not always, a sensation of chilliness, 
never rigor ; the face is pale. Flushing of the face and 
great heat rapidly succeed, with a high temperature of 
the body. The pulse is remarkably frequent, out of 
proportion to the height of the fever. ' The respiration is 
in proportion to the pulse. No cough. The tongue 
mostly covered with a light white fur, except at the tip 
and edges, which are red ; in some cases it remains quite 
pale, clean and moist. There are loss of appetite and 
thirst in marked cases of the disease. The skin is hot, 
but not necessarily dry. There are numerous symptoms 
present, languor, sleepiness by day and disturbed 
sleep at night, with some delirium. Lastly, in mild 
cases, mere " poorliness " the day before the eruption is 
often the only premonitory symptom. 

The duration of this stage of the disease is, as a rule, 
from twelve to thirty hours. In trivial cases the rash is 
sometimes the first symptom of the disease. 

The Bash. — The normal exanthem consists of small 
dots, in color bright scarlet, most intense at the center 
of the dot, fading toward the edges ; confluent by their 
margins, so as not to leave any skin of normal appear- 
ance between ; not elevated to the touch ; completely 
disappearing under pressure, and rapidly reappearing 
when the pressure is removed. The rash generally comes 
out first on the sides of the neck and upper part of the 
chest, but sometimes over the whole body at. once. 
This rash or eruption reaches its maximum extent and 
intensity on the third or fourth day of the illness 
(sometimes earlier), and begins to fade on the fourth, 
fifth or six days, and lasts altogether from Rye to ten days. 



302 THE FAMILY PHYSICIAN 

Sore throat is always present in some degree ; on ex- 
amination it will be seen that the palate, uvula and 
tonsils are very red, and sometimes much swollen. 

The fever runs higher than in measles, but not so high 
as in intermittent and remittent fevers. On the day the 
eruption begins to fade the fever frequently submits to a 
complete crisis, as indicated by the temperature not rising 
above the normal for twenty-four hours. Should this 
crisis not occur the disease will be prolonged for an inde- 
finite period. These are the symptoms of ordinary scar- 
let fever ; but there are other forms, termed the malignant 
and the latent, or simplex. In the malignant the severity 
of all the symptoms are augmented. This term or 
epithet, malignant, is rather a loose term, and is used 
whenever the life of the patient is threatened in the first 
or second week of the illness, and is applied not only to 
cases of sc. maligna proper, as above defined, but also 
to cases of ordinary scarlet fever, attended with compli- 
cations, ulcerated sore throat, inflammations, hem- 
orrhage, &c. 

The severer, the more pyretic forms of ordinary scarlet 
fever, merge into a type of malignity characterized by 
excitement, followed by exhaustion. There are all grades 
of severity between this, the least grave form of malig- 
nity and that which places scarlet fever almost on a foot- 
ing with Asiatic cholera and the plague, that form in 
which a preliminary period of excitement is hardly to be 
perceived, so rapidly does collapse follow upon the onset 
of the disease (adynamic, congestive, protojpathic malig- 
nity). 

LATENT SCAELET FEVEK. 

In this the symptoms are so ill-developed as to be not 
characteristic or not observed. Examples of Sydenham 
scarlet fever — disease by name alone — hold a mid place 






AND GUIDE TO HEALTH. 303 

between this latent and the regular forms. However 
mild the primary disease may be, the gravest sequelae 
may ensue. 

TEEATMENT. 

This disease belongs to that class that has a certain 
course to run, and of course can not be "broken up," 
but must be carefully guided through, if possible. A 
large part, then, of the treatment of a case of ordinary 
scarlet fever may be summed up, as Dr. Samuel I. Gee, 
of London, says, in " nursing." He adds : " The patient 

:.-:tVJB9 

should be put to bed, as a rule to which there is no ex- 
ception ; the bed clothes should be those to which he has 
been accustomed in health, and no more ; carpets and 
porous materials must be removed ; the bed-room should 
be carefully ventilated, bearing in mind that there is no 
special reason to fear cold during the first week; the 
whole surface of the body should be sponged with tepid 
water once or twice a day, and subsequently to grease 
the skin with mutton suet often brings comfort to the 
patient. The diet is to be unstimulating, consisting of 
milk, the farinacea, an egg, light pudding ; drink should 
be freely supplied — iced water or iced lemonade or toast 
water. Purgatives are to be avoided. Dr. W. T. Gaird- 
ner says : " Another disease will not be easily found in 
which delirum is more common and less dangerous ; in 
scarlet fever the patients wander even on the first day, 
and sometimes, although they are free from any other 
sign of danger, they do not cease to talk at random every 
night from the beginning of the disease to the end." 
Delirium, however, to be an unimportant symptom must 
be isolated; severe vomiting, diarrhea, any unusual 
symptom referable to the nervous system concurrent 
with delirium, make it grave in a prognostic sense. In 
many cases a consideration of the previous and present 



304 THE FAMILY PHYSICIAN 

condition of the patient will indicate the administration 
of wine ; the child seems low, the pulse is not only fre- 
quent, but soft and feeble, there is possibly coryza pres- 
ent ; at the same time full doses of carbonate of ammonia 
should be given in milk every four hours. And it must be 
conceded that no great harm comes from the moderate 
employment of stimulants, even when they are not abso- 
lutely necessary. 

When the throat is much inflamed great relief may be 
afforded by the free use of ice, the patient allowing a 
lump of it to dissolve in his mouth ; under this treatment 
the soreness often passes away in a short time. The 
puffy swellings of the neck may be removed by the use 
of a warm linseed meal poultice, often renewed. When 
the coryza is troublesome the nose must be syringed 
with a weak solution of nitrate of silver, four grains to 
the ounce, or with strong salt water, warm. Dr. Lee 
says : " Of the remedies employed in the treatment of 
the malignant form of scarlet fever there is one which 
stands out from among the rest — the cold affusion. Yet 
it is not of equal value in all cases. From the days 
of Currie downward the ataxic form of the disease, 
characterized by delirium, diarrhea, vomiting, full pulse 
and great heat of skin, has been recognized as the special 
indication for this active treatment. The patient is to 
be seated naked in a bath, two or three buckets full of 
water at 70 ° Fahr. are poured quickly over him, so that 
the affusion does not last longer than half a minute ; he 
is then returned undried into bed and laid between 
blankets. The first affusion having had a markedly 
beneficial effect, should the indication symptom return 
in the course of the same day or next, the water treat- 
ment may be repeated, and this even two or three times 
if necessary. When this treatment has been objected 



A3"D GUIDE TO HEALTH. 305 

to or has seemed too bold, I have seen very good results 
follow from packing the patient in a wet sheet for an 
hour. A still milder method remains to be mentioned — 
that of occasional cold sponging. Ammonia and brandy 
are nearly always needed, sooner or later, by these pa- 
tients." In the more prolonged cases quinine must be 
used in connection with the ammonia and brandy. A 
most nutritious diet in connection with these will often 
enable such patients to recover. 

"However favorable an attack of scarlet fever, the 
patient should be kept," says Dr. Lee, " in bed for three 
weeks from the commencement of the disease ; he may 
then get up, but he should not leave his room for another 
week." 

If on the morning of the fifth or sixth day any ulcer- 
ous appearance that the fauces may have previously 
presented does not show signs of yielding, it is well to 
cauterise the morbid surface. For the tonsils undiluted 
hydrochloric acid is to be used ; for any part of the soft 
palate solid nitrate of silver. These applications must 
be made but once, or if they are repeated it must be 
after four or Hive days. The external swellings must be 
continually poulticed with the flaxseed meal, and as soon 
as pus has formed, however small the spot, an incision 
must be made into it and the matter let out, then resume 
the poultice. A free discharge of sloughs and ichor af- 
fords the patient his sole chance. Should hemorrhage 
occur, the wound is to be stuffed with lint soaked in a 
solution of perchloride of iron ; this moderate pressure 
will stop the bleeding, which is oftener venous than 
arterial. 

If swellings occur in the ears they must be syringed 
with warm water frequently. Should a discharge, either 
20 



306 THE FAMILY PHYSICIAN 

from the ear or nose, become chronic, quinine and elixir 
of vitriol must be taken. 

The suppurative tendency is an indication for quinine, 
fresh air and substantial food. All abcesses are to be 
opened early. The treatment of rheumatism when it 
occurs in scarlet fever is palliative ; Dover's powders to 
allay pain, diluents for concentrated urine, aperients if 
necessary, and poultices to the affected joints. 

Sloughing of the cornea would probably be preventable 
in many cases by the simple expedient of keeping the 
eye shut, as recommended first by Trousseau. 






AND GUIDE TO HEALTH. 307 



MUMPS-PAROTITIS. 

CYNANCHE PAROTLDEA. German, ZIEGENPETER. 



Mumps is an acute disease, characterized by a lesion 
on one or both parotid glands. It is a 

CONTAGIOUS 

disease, not usually occurring a second time, subject to 
epidemic influences, and said to be most common in 
spring and autumn. Its period of incubation varies from 
eight to twenty days. 

SYMPTOMS. 

The first symptom usually noticed is a sensation of 
chilliness, rarely amounting to rigor, pain in the head, 
back and limbs; the pulse and respiration are both 
accelerated. In a few hours there is a pain felt in one 
or both parotid glands, followed shortly afterward by 
swelling of the glands and stiffness of the jaws. These 
glands are situated immediately beneath the ear and 
back of the jaw — the lock of the jaw, as I have heard it 
termed. The pain and swelling first appear immediately 
beneath the ear, and posterior to the ramus of the jaw, 
and from this part spread in all directions, upward to the 
face, and downward and backward into the neck. The 
swelling disappears in the inverse order of its invasion. 

A common mode of diagnosing when this disease is 
suspected by the common people is to have the patient 



bud THE FAMILY PHYSICIAN 

take something acid into the month, snch as vinegar, 
sonr buttermilk, etc., which produces a very nnpleasant 
sensation, and one the patient will not be likely to hear 
long. 

The termination is almost always favorable, but from 
carelessness or other causes the disease may affect other 
organs. In many the testicles, one or both, may suffer ; 
whilst in the female the mammse (breasts), laba rnajora 
(lips of genital organs), and uterus are the parts occa- 
sionally attacked. The tonsils and pharynx may also 
be involved. 

The duration of the disease is from four or five to ten 
or twelve days. The pain and swelling under the ear 
are its characteristic symptoms ; and when it prevails 
epidemically, or to any extent by contagion (which in 
fact is the only way that we positively know that it can 
prevail, the epidemic being more or less speculation), 
there will be no difficulty in recognizing it. 

TREATMENT. 

In common with other acute specific diseases, mumps 
has a certain course to run, and can not be arrested in its 
course by any mode of treatment. All that can be done, 
then, is to mitigate the severity of the symptoms, and 
thus conduct the disease to a favorable termination. For 
this purpose but little treatment is required. In order to 
prevent any metastases, or transfer of the disease to 
other parts, the patient must be put to bed and given a 
mild dose of some saline cathartic ; active purging must 
be avoided. 

Eest must be strictly enjoined on the patient, for it is 
found that in all febrile diseases exercise always in- 
creases the febrile excitement. Morphine in moderate 
doses, say one-fourth of a grain to an adult, should be 
given to ease the pain and promote sleep. 



AND GUIDE TO HEALTH. 309 

The appetite must have strict regard paid to it, for the 
increased waste of the tissues is compensated for in pro- 
portion to the amount of food digested. Should no food 
be taken or assimilated, the patient is placed in all 
respects in the position of a starving person, and to this 
must be added an active, increased consumption of the 
tissues. To secure or promote the appetite and proper 
digestion of the food, attention must especially be paid 
to pain, sleep and the nature of the food. Pain, if severe, 
destroys entirely the appetite and arrests the digestion 
of food; therefore, if the pain in the affected organ is 
great, it must be allayed by the use of morphine, as 
above stated, or by what is really better in this case, 
Dover's powders, in from five to ten grain doses. Hot 
fomentations or poultices will be found serviceable in 
relieving pain. The thirst can be removed by sucking 
ice. The food should be selected with two objects in 
view — first, that it shall not need chewing, for that would 
increase the pain in the affected part ; second, that it is 
nutritious and easy of digestion. With these objects in 
view, milk and mush, eggs, rice, beef tea, or good strong 
mutton or veal broth may be used. It must be remem- 
bered that digestion is generally poor in all febrile dis- 
eases, hence the food must be given in small quantities 
and often. If the case is protracted or the patient is very 
weak* from previous disease, good wine or brandy must 
be given. 

Owing to the mildness of this disease, and its almost 
universal favorable termination, but little treatment is 
necessary ; but it must be remembered that even mumps 
sometimes terminates fatally, and at other times, owing 
to the implication of other organs, becomes quite a serious 
disorder. It is always best to use great care and if pos- 
sible avoid such results. This may always be done by 
a proper course. 



310 THE FAMILY PHYSICIAN 



CHICKEN POI-VARICELLA. 



This is a contagious febrile disease, which is attended 
with an eruption of vesicles ; does not last longer than 
a week, and does not recur a second time in the same 
individual. It is very mild and never terminates fatally. 

SYMPTOMS. 

Slight feverish symptoms precede the eruption by a 
few hours. The eruption appears in the form of small 
rose spots, from ten to fifteen coming out on the first day 
on any part of the body. On the second day there may 
be a hundred or more, those of the first day having by 
the second a clear water in them, the patient having the 
appearance of having had a shower of scalding water 
upon him. This nocturnal outburst of spots is repeated 
for four or five successive nights, the spots becoming 
vascular in ten hours, which soon become "scabs." 

TREATMENT. • 

Children should be as much as possible prevented 
from picking the scabs, on the face at least, for fear they 
should leave marks or pits. A little wine, brandy or 
quinine may be given, especially during convalescence. 
Care is all that is generally necessary. 



AND GUIDE TO HEALTH. 31 1 



DIPHTHERIA. 

CYNANCH, ANGINA, 



TMs disease is both, epidemic and contagious; it is 
a special inflammation of the mncons membrane of the 
throat and air passages, attended with enlargement of 
the lymphatic glands. 

The disease is accompanied by great prostration of the 
vital powers, and is followed by a remarkable series of 
local lesions of innervation. 

There is little donbt that diphtheria, like other acnte 
specific diseases, has existed as long as the history of 
man extends. We have traces of it two thousand years 
ago, and the description of it more than a thousand 
years since applies equally to its appearance in our own 
day. It is not difficult to recognize during its epidemic 
prevalence; at other times its distinctive characters have 
been merged with those of scarlet fever and erysipelas. 
There was no discrimination made in these diseases 
even in Sydenham's time. Hippocrates describes it, and 
gives us the name of, probably, its first recorded victim. 
Hippoc, Epid. lib. v, tex. 57. Aretseus is the founder of 
both our knowledge and treatment of the disease. It is 
impossible to say which one of the many plagues of the 
dark ages of history may claim this disease as its agent. 

The recurrence of diphtheria more than once in the same 
subject is not settled so conclusively in the affirmative 



312 THE FAMILY PHYSICIAN 

as has been generally supposed. That the same person 
may be repeatedly attacked with the slighter forms of the 
malady, and that some are so on the slightest exposure, 
is frequently observed ; but when the fully formed dis- 
ease has been undergone, though relapses are to be 
feared in convalescence, even during the whole of the 
subsequent period of debility, which may be prolonged 
for two or three months, independent recurrence is rare, 
and a less tendency to the disease is observed. 

SYMPTOMS. 

Constitutional symptoms precede those occasioned by 
the concomitant local changes. Among the earlier 
symptoms are yawning or sighing, shallow and infrequent 
respiration, great lassitude and debility (this symptom 
is observable throughout the whole course of the disease 
and is one of its characteristics), there is some aching of 
the back and legs, chilliness, pallor, a sense of nausea 
or rising in the throat, sometimes vomiting, and in child- 
ren diarrhea, headache or a sense of constriction across 
the forehead, vertigo, extreme muscular weakness, an 
altered mental state, slowness of recollection, an indiffer- 
ence of manner, and an obtuseness of the mental 
faculties ; this latter will sometimes give place to slight 
excitement at night, when wakefulness or restlessness is 
almost always to be observed. The pulse is accelerated, 
and in children or young persons may rise to 120 or even 
140 beats in a minute ; this soon subsides, always before 
the end of the second day, and though the pulse con- 
tinues to be quick it is either feeble or easily compressed. 
The breathing is never proportionably accelerated at this 
period. The tongue is moist, with a thin, creamy fur; the 
urine is pale in color, at first free, but soon rather less in 
quantity ; there is redness, with a little swelling of the 



A^D GUIDE TO HEALTH. 313 

posterior part of the soft palate, of the fauces, and of the 
tonsils. The throat is sore, swallowing is difficult if not 
painful, and sometimes pain is felt in the ear. The 
earliest evidence of the disease is found by a deposit of 
the exuded serum in the follicles of the tonsils or on their 
inflamed surface. 

The first general symptoms are transient, and may be 
so trifling in degree as to escape notice until they are 
intensified by the progress of the local lesion ; this will 
give rise to pain, heat and soreness of throat, with im- 
peded function ; it also excites some sympathetic febrile 
disturbance of its own, and always increases that proper 
to the general disease ; where both are severe, the throat, 
though covered with exudation, is often the least part of 
the patient's complaint ; where both are slight, there may 
be an interval in which little complaint is made. During 
this interval, which will not exceed two days, there may 
be no visible exudation in the fauces ; the tonsils con- 
tinue to be enlarged and their surfaces irregular, and 
they, in common with the whole of the pharynx, the 
arches of the palate, the velum and the uvula, are of a 
deep red color and unequally tinged ; one side is gen- 
erally the most affected. The uvula is enlarged, red and 
glistening, and a mottled redness extends forward from 
it over the soft palate, but the rest of the membrane is 
pale. Some of these parts soon appear more tumid and 
glistening than others, and spots at first semi-transpa- 
rent, afterwards opaque, rapidly form and coalesce, so 
that in a few hours a large surface may be covered with 
a continuous layer of exudation. 

A careful inspection of the fauces will, in the majority 
of cases, be conclusive as to the presence of the disease ; 
when a yellowish patch of exudation, moulded to the 
surface it has invaded, is thus brought into view, the 



314 THE FAMILY PHYSICIAN 

nature of the serious illness, which, may have been ob- 
scure, is at once revealed. 

As above remarked it will not be difficult to diagnose 
this disease when it prevails as an epidemic. 

]STo case of diphtheria is to be regarded without anxiety ; 
every danger incident to the disease may result, though 
the early symptoms are but slightly marked. The suc- 
cessive appearance of fresh patches of deposit, or of 
other signs of the disease, excites alarm, lest its next 
local manifestation should be in the larynx. This the 
young or the feeble would scarcely withstand. 

TREATMENT. 

The general therapeutical indications are of primary 
importance throughout ; they consist neither in attempt 
to nullify a poison by specifics nor to expel it in elimi- 
nation, but in withstanding the encroachment of the dis- 
ease and in sustaining the vital powers. 

Complete rest and purity of air are essential. The 
first general symptoms should be met- by alcoholic sti- 
mulants, freely administered; there should be good 
brandy or wine — the brandy in the form of a toddy. 
These are more directly serviceable in the earliest stages 
of the disease than even in that part of its course when 
they become indispensable. A rapid pulse indicates 
their employment, and heat of skin is no counter indica- 
tion. One or two five grain doses of quinine should be 
given when there is either vertigo, headache or vomit- 
ing ; soon afterward beef tea, eggs, or even more solid 
food, can be taken, as well as the brandy or wine ; milk, 
in any form, is always suitable. The night must not 
pass without either nourishment or stimulant being 
given, or both. Wakefulness or nocturnal delirium is 
often thus obviated. Sometimes a dose of morphine or 



AND GUIDE TO HEALTH. 315 

opium has to be combined with the stimulant on the 
second or third night if restlessness then persists ; in 
fact morphine or opium may be given in small doses 
from the first, with the stimulants, with advantage. 

When a patch of exudation is already apparent a 
solution of nitrate of silver should be applied, so as to 
thoroughly come in contact both with the patch and the 
turgid mucous membrane surrounding it. The strength 
of the solution should not exceed the proportion of one 
part of nitrate of silver to three parts of water (the water 
used with nitrate of silver must always be rain or soft 
distilled water). The superficial whiteness left by it will 
clear off in twenty-four hours, and is easily distinguish- 
able from the points of exudation. A mixture of hydro- 
chloric acid and honey in equal proportions or with one 
or two parts of water is as effectual in checking the pro- 
gress of the exudation, but leaves a more persistent white 
mark. These applications, when seen to be efficient, need 
not be repeated ; care should be taken that no excess 
of them reach beyond where they are required. The 
strong acid and solid nitrate of silver are both objection- 
able. "When there is much redness and pain, a weaker 
solution of nitrate of silver — one part to eight or twelve 
of water — penciled over the whole surface tends to pre- 
vent further exudation and affords relief to the local 
discomfort. Hydrochloric acid diluted with five or six 
parts of water may be applied in the same way with the 
same effect. As soon as nourishment, however light, can 
be retained by the stomach five to ten grains of the per- 
chloride of iron, the equivalent of twenty or forty drops 
of the tincture, should be given with not less than half 
an ounce of water and half a drachm (half a teaspoonful) 
of glycerine ; this should be repeated every three or four 
hours or even more frequently. It should be commenced 



316 THE FAMILY PHYSICIAN 

on the first day of the illness, or as soon as the patient 
comes under notice, and continued until the tongue be- 
comes red and the throat improves. When deposit has 
already taken place the good effect of the remedy will be 
shown, not by any alterations in the dimensions of the 
patch, but by a diminution in the accompanying secre- 
tion and by an improvement in the general symptoms. 
It is not to be discontinued for some days, and may re- 
quire energetic repetition if improvement is slow in 
appearing. The tincture of the muriate of iron in twenty 
to forty drop doses in half a tumbler of water will answer 
the same purpose of the other preparation. 

A local as well as a general influence is exerted by 
these agents ; they have a constringing effect on the 
vessels, and their action on the decomposing exudation is 
antiseptic. Difficulty of swallowing is often a serions 
aggravation of the illness. Lime water may be used for 
a week as gargle or glycerine applied with a camel's hair 
pencil, either of which alleviates ; so also does an injec- 
tion of cold water into the pharynx. Ice in small pieces 
dissolved in the mouth is at once the most grateful as 
well as the most nseful appliance. A weak solution of 
borax or alum with glycerine or honey or a strong solu- 
tion of chlorate of potash are useful where there is much 
tenacious secretion. 

As long as solid food can not be taken it is to be noted 
with the greatest exactitude that the quantity of the 
liquid nourishment and of stimulant administered in the 
twenty-four hours is equal to the estimated requirement 
of the patient ; the less the quantity of nourishment the 
greater must be the dependence upon the stimulant. The 
youngest children may require a teaspoonful of brandy 
every two 1 hours, and a child of three years old two tea- 
spoonfuls. This may be given diluted any way and in 



AND GUIDE TO HEALTH. 317 

very small quantities, frequently repeated. Older chil- 
dren or adults take it best mixed with ice water or soda 
water. Norton's Virginia Seedling wine is a good sub- 
stitute and will prove a valuable article in the treatment 
of this disease. 

At a further period of the disease, when the separation 
of the deposit is completed, extra stimulants are required 
to combat the restlessness and depression then sometimes 
extreme. Sleep, at all times necessary, is at this latter 
period of the illness to be carefully conciliated. Opiates 
are well borne, and are now more likely to procure sleep 
than when the first symptoms in the throat are most 
troublesome ; their use for several nights, when the dimin- 
ished exudation reveals injury of the mucous membrane, 
may do much to prevent the exhaustion at this time so 
dangerous. Quinine and barks at this period must be 
freely used. 

Aperients are seldom required at the commencement 
of the illness, and during the earlier stages their effects 
seem to be injurious, for then the waste of tissue is most 
active and the impediment to the reception of nutrition 
the greatest. If diarrhea set in it may be controlled with 
opium or opium with bismuth. The constipation of the 
latter stages of the illness require stimulating injections. 
Cold water or iced lemonade should be allowed through 
the whole course of the disease. 

If suffocation is about to take place tracheotomy should 
be performed ; for this purpose the services of a surgeon 
must be secured. After the operation the chief condition 
of success is efficient support. The tube must remain in 
the trachea for at least a week. 

The after treatment of diphtheria requires great care 
in proportioning the amount of exertion to the degree of 



318 THE FAMILY PHYSICIAN 

strength existing. Good food, good air and tonics are 
necessary. 

Mercury, if continued to its general effect in this dis- 
ease, would prove of much injury, while bleeding is 
wholly inadmissible, the principle being to sustain the 
system while the local symptoms are being combated 
and the lesion removed. 

The disease is a dangerous one, and when it prevails 
in the epidemic form brings with it great consternation 
and destruction ; but if carefully treated on the above 
principle it is disarmed of its terror and is more or less 
tractable. It, like croup, should receive early attention, 
to be treated successfully, and furnishes another reason 
why every one should be acquainted with diseases and 
their therapeutics. 



AND GUIDE TO HEALTH. 319 



MEASLES— FLECKEN. 

RUBEOLA. 



Measles is an acute febrile contagious disease, mostly 
occurring in epidemics. It generally attacks the patient 
but once ; sometimes occurring again, but very seldom. 
It often co-exists with other epidemics, particularly 
whooping-cough. The one epidemic seems to predispose 
to the other, and when it follows whooping-cough the 
cough is generally prolonged. The period of incubation 
is from seven to ten days ; it is produced by inoculation 
in seven. 

SYMPTOMS. 

The disease is generally abruptly ushered in with chil- 
liness and rigor ; and sometimes in children by convul- 
sions ; or, on the contrary, the invasion is so insidious 
that it is impossible to determine with accuracy the first 
day of attack. The establishment of the disease is 
accompanied with a degree of prostration, enough to 
plainly suggest to the servants of nature the principles 
of treatment. The patient takes involuntarily to bed, 
and is indisposed to either physical or mental exertion. 
He is fretful and irritable, in some cases only when dis- 
turbed ; in others they are constantly restless, whining 
and peevish — differences dependent on peculiarities in- 
herited or developed by bad education. The expression 
is vacant, and the powers of perception and reflection 



320 THE FAMILY PHYSICIAN 

are much impaired. Delirium is in some cases present, 
always slight, and usually limited to the night. The 
skin is hot and dry ; the lips are parched, and in severe 
cases covered with sordes (dark deposit). The tongue is 
coated, the appetite is much impaired, and the thirst ex- 
treme. Yomiting, when present, indicates a severe attack 
of the disease. The eyes are generally a little red and 
suffused with tears, and easily affected by light. There 
is sometimes frequent sneezing, accompanied by a watery 
discharge from the nose, resembling the commencement 
of a " cold." The mucous membrane of the mouth and 
throat is mottled with redness. The throat is sometimes 
sore ; the cough is dry and hacking. The voice is often 
hoarse. 

Usually on the fourth day from the commencement of 
the disease the characteristic rash appears. First noticed 
on the forehead close to the scalp, and on the chin, it 
from thence spreads over the face, trunk and extremities, 
in the accomplishment of which it occupies a period 
occupying from two hours to two days. On the appear- 
ance of the rash the fever is stated to increase — it cer- 
tainly does not diminish. The watering and redness of 
the eyes increase. There is slight swelling of the whole 
body, more noticeable in the face. 

After the second or third day of the eruption the fever 
disappears, the temperature becomes normal, the pulse 
much less frequent, and the patient at once enters on the 
period of convalescence. 

The severity of the disease varies greatly. This has 
led to the division of it into three forms. The mildest 
form the learned doctors call morbilli sine catarr7io, the 
next or middle form morbilli mitiores, and the malignant 
or worst form morbilli graviores. This is the form that 
we sometimes hear termed the " black measles" or by 



AND GUIDE TO HEALTH. . 321 

some the " French measles." Tins form, it would seem 
from medical history, was far more prevalent formerly 
than now, still cases do now and then present themselves. 
In this form the rash often only imperfectly appears, 
and is of a livid, purplish, or even black color — from 
whence its name. In these cases when they terminate 
fatally it is generally from diarrhea or bronchitis. 

This malignant form of measles is always attended 
with danger ; it often becomes complicated with such 
formidable diseases as pneumonia, laryngitis, bronchitis, 
or acute tuberculosis (consumption). Besides those, many 
dangerous and troublesome sequelae often follow in its 
"wake." 

TKEATMENT. 

Dr. Sydney Ringer, to whom I am indebted for much of 
the information in this article, and who acknowledges his 
indebtedness to Williams, Armstrong, Trousseau, Graves, 
Hebra, Rilliet, Barthez, Aitken, Parks, et al., says in 
regard to the treatment of measles, " Not possessing any 
medicine capable of shortening the duration of the dis- 
ease, it must be our object in treatment to conduct the 
fever to a favorable termination, and to ward off any 
intercurrent disease." The remarks made respecting the 
treatment of measles of course apply for the most part 
to all febrile diseases, and especially to those of long 
duration. 

The patient must be confined to bed. Too much light 
should be excluded, for strong light is annoying to all 
febrile patients, and in measles causes some pain in the 
inflamed eyes. 

The room should be well ventilated ; all excreta and 

dirty linen should immediately be removed. The patient 

must be most carefully protected from drafts. The sense 

of heat and dryness of the body, sometimes most dis- 
21 



322 THE FAMILY PHYSICIAN 

tressing to the patient, can be much alleviated by wash- 
ing the surface with soap and tepid water; too great 
exposure avoided by one part of the body being cleansed, 
dried and covered before the rest is exposed. 

All sources of annoyance or irritation, and all noises, 
should be avoided, and thus sleep be promoted — a con- 
dition which most materially affects the welfare of the 
patient — sleep lessening the fever and increasing the 
appetite. Food, light and nutritious, such as rice, 
gruel, beef tea, chicken broth, milk, jellies, etc., etc., 
should be given at the usual meal hours. The quantity 
should be moderate, care being taken not to give enough 
to impair digestion. There is no stimulant so important 
as food. The prospect of recovery in all acute febrile 
diseases is very greatly, if not mainly, dependent on the 
power possessed by the patient of digesting and assimi- 
lating food. If there be oft-repeated sickness (as there 
often is in "black measles"), which is an unfavorable 
symptom, for sickness itself very greatly prostrates the 
patient, and by the vomiting the nutritious matter is 
returned — nay more, the vomiting is due to a condition of 
the mucous membrane of the stomach and alimentary 
tract most unfavorable to digestion — in this case food of 
the blandest form, such as " Liebig's beef tea " — which is 
made by cutting one pound of beef very fine, pouring on 
it one pint of water, to which has been added thirty drops 
of hydrochloric acid and forty grains of salt, allowing it 
to stand three hours, then strained and strongly ex- 
pressed, when it is fit for use — should be given. The 
uncooked white of an egg, well beaten and diluted with 
water, with a little crushed sugar added, should also be 
given. 

The thirst may be allayed by cold water, which 
should be taken in small quantities and swallowed slowly. 



AND GUIDE TO HEALTH. 323 

One-fourtli of a pint of water swallowed very sloAvly will 
do more toward quenching thirst than a pint swal- 
lowed in great haste. This is a fact that it is well for all 
to remember. A person that would drink rapidly three 
or four tumblers of water in succession would scarcely 
consume one if he would take a teaspoon and dip it out 
and swallow it a spoonful at a time. A small lump of 
ice held in the mouth, swallowing the water as it dis- 
solves, is a good way to allay thirst without taking too 
much water into the stomach. The objection in measles 
to taking too much water into the stomach is that it tends 
to impair digestion, and sometimes causes diarrhea. The 
patient, however, must be permitted to take larger quan- 
tities of fluids than in health, as an increased quantity 
is required by the system during the existence of fever.. 
Lemonade is a useful drink in measles, and in fact in all 
febrile diseases, and is always grateful to the stomach. 

Stimulants are administered to support the strength of 
the patient. This they do in a great measure by pro- 
moting digestion, and also by directly increasing the- 
heart's action. In cases where the patient has been in 
rather feeble health previous to the attack, or where 
there seems to be much prostration, the administration 
of stimulants must be commenced early in the disease,, 
and used to such an extent that the system will be sus- 
tained ; by this means many of the troublesome sequels 
will be avoided. If the patient is robust and can take 
nourishment, it will scarcely be necessary to use stimu- 
lants in any of the early stages, but it will always be 
found necessary before the close of the disease to use 
some. Alcoholic stimulants in some form or other will, 
be found the most useful in measles. 

In the commencement of an attack of measles the 
bowels should be opened. This may be done with a: 



324 THE FAMILY PHYSICIAN 

small dose of castor oil, or by the use of the syringe — the 
latter means being preferable. The bowels are very 
easily acted upon in measles ; this must be remembered, 
and no active cathartic given. 

If bleeding at the nose supervene it must be stopped. 
This can usually be done by injecting into it cold water; 
if this fail it must be plugged. 

If any complications arise they must be treated ac- 
cording to their nature, remembering that no kind of 
depletory treatment can be borne by a patient with 
measles. With this plan in view, use what is indicated 
by the symptoms. 

A proper amount of sleep is absolutely necessary, as 
well as a proper amount of digestible food. Opium will 
seldom be necessary in the treatment of measles ; but if 
sleep can not be procured without it, it must be used. 

It may be wondered at by those who have been in the 
habit of drenching patients with hot tea, hot whisky 
toddies, &c, that I have not recommended some of 
these articles to " break out " the rash or " measles." I 
have not done so simply because they are not indicated, 
and because they do the patient a positive injury by fill- 
ing the stomach with fluids, thereby impairing digestion, 
a thing all important in the successful treatment of 
measles. JSTow, I hope this hint will be sufficient ; and 
when the poor sufferer calls for drink to quench a thirst 
that is consuming him he will not be given hot tea, 
made, as is often the case, from the excrementitious 
matter of the sheep, or made out of pepper, or some 
other article not calculated to quench his thirst. The 
patient with measles feels, perhaps, about as badly and 
mean, as disagreeable and trifling as he possibly can. 
I have often been reminded when seeing a patient with 
one of the "bad" forms of measles of a remark a little 



AND GUIDE TO HEALTH. 325 

niece of mine, about five years old, made jnst prior to 
the coming out of the measles rash on her. After several 
most piteous groans she remarked, with much earnest- 
ness, that she " wished she never had been any thing," 
and that she was " not very much as it was in this fix." 

The very mildest form of measles scarcely needs treat- 
ment at all, farther than to keep the patient comfortable 
and in bed. Like many other contagions diseases, the 
young suffer less with it, as a rule, than those advanced 
in life. 

Inoculations for measles may be done and the disease 
avoided altogether, but there does not seem to be terror 
enough about the disease to cause persons interested to 
feel much interest in inoculation. It is thought to be 
more contagious than either small-pox or scarlet fever. 



326 THE FAMILY PHYSICIAN 



WHOOPING-COUGH. 

(Cullen), MOEBUS CONTAGIOSUS. — (French), CO- 
' QXJELUCHE.— (German), KIK HUSTEK — (Techni- 
cal), TUSSIS COJSTULSIVA. 



This is a convulsive cough, consisting of a long series of 
forcible expirations, followed by a deep, loud, sonorous 
inspiration or whoop, and repeated more or less fre- 
quently during each paroxysm ; occurring usually in 
childhood, and once only during life, continuing several 
weeks. 

No writer before the middle of the seventeenth century 
had described this disease ; from this fact we are led to 
believe that the disease was unknown to the fathers of 
medicine, for it is difficult to believe that a disease 
having characteristics so well marked as this could 
escape their attention, and a description of it be given 
so that we could recognize it. Diseases having a conta- 
gious or epidemic character, and resembling " whooping- 
cough " in its catarrhal symptoms, were clearly known 
to Hippocrates and others before the Christian era, and 
have been described by Arabian, Italian and French au- 
thorities down to the sixteenth century, but lacking the 
distinctive character of the whoop. They more nearly 
resemble influenza than any disease now known to us. 
Hence its history can not be traced back more than 
about two hundred years. It is claimed, however, that 



AND GUIDE TO HEALTH. 327 

it has been known traditionally by the French for over 
three hundred years. This is doubtful. 

CAUSES. 

There is no known specific cause to which it can be 
attributed ; but that atmospheric influences are chief 
exciting causes may be inferred from the fact that it has 
often occurred as an epidemic, and that it is most preva- 
lent at certain seasons of the year. The imperfection of 
our knowledge in reference to atmospheric influences 
other than temperature, and the absence of registration 
of the prevalence of diseases which do not end fatally, 
prevent a more minute inquiry into this relation. The 
fact that whooping-cough is, without a reasonable doubt, 
a contagious disease implies a materies morbi, generated 
or at least acting within the body, is communicated from 
one person to another, and that the atmosphere is the 
vehicle for its transmission; but as we know nothing 
of the nature of this materies morbi within the body, so 
we are equally ignorant of its character when existing 
without it. 

SYMPTOMS. 

The early evidences are those of simple catarrh without 
any, or with scarcely any, febrile complication. They are 
coryza, secretion from the nose, cough more or less severe, 
but not at this stage spasmodic, with frothy and watery 
secretion from the bronchi, lassitude, restlessness, and 
some diminution of appetite. After a period the cough be- 
comes a more marked symptom, and is louder and more 
prolonged than an ordinary cough, generally putting on a 
spasmodic character. When the nature of the disease 
has become quite clear the cough is found to occur in 
paroxysms, during which the body is bent forward and 
a series of short, very rapid and violent expirations occur 



328 THE FAMILY PHYSICIAN 

and continue until the face is extremely suffused and the 
respiration seems almost to have ceased, when a deep, pro- 
longed, loud and crowing inspiration takes place. This 
alternation occurs two or three or more times in each 
paroxysm. The attack terminates with the emission of 
a somewhat large quantity of semi-transparent, glairy 
and very tenacious mucous, which hangs about the mouth 
and lips, and not unfrequently with vomiting = In mild 
cases the disease may soon end ; but in more severe cases 
there remains much exhaustion and emaciation, attended 
by an insufficient appetite and increased sensibility of 
the stomach, which leads to vomiting from trivial causes. 
The skin is usually soft, and at the end of a paroxysm is 
bathed in perspiration. Bleeding from the nose is a 
very frequent attendant upon a severe attack of whoop- 
ing cough. In a typical case the catarrhal symptoms, 
without spasmodic cough, continue about two or three 
weeks, and the spasmodic cough for three or four weeks, 
whilst after the spasm has ceased and the cough has be- 
come again catarrhal the duration may be short, if the 
child has not been too much enfeebled ; otherwise it will 
be prolonged for some weeks. 

Whooping-cough may be complicated in two ways — 
when the cough supervenes upon some other disease and 
complicates it, and when whooping-cough is primary and 
other diseases arise in its course. The former class is a 
somewhat extensive one, but for the most part is limited 
to diseases, such as measles, which involve bronchial 
affections in their course ; the latter, however, only will 
be considered here. The complications are of four kinds, 
viz. : disease of the lungs, disease of the brain, infantile 
remittent fever, and vital exhaustion. The last may be 
regarded by some as a sequel of uncomplicated whooping- 
cough ; but when it is considered that the almost infinite 



AXD GUIDE TO HEALTH. 329 

proportion of the cases of simple whooping-cough end 
favorably with only a moderate state of exhaustion, it 
will be thought better to regard the very exceptional 
occurrence of fatal exhaustion as a complication rather 
than as a sequel to the simple form. The pulmonary 
complications are : congestion of the lungs, emphysema, 
atrophy, bronchitis and "broncho -pneumonia. A certain 
amount of congestion of the lungs is found in all cases 
of severe whooping-cough, and is due perhaps exclusively 
to the interference which occurs through the respiration 
and with the pulmonary circulation, and it is one of the 
sources of danger attending the disease. 

Emphysema (infiltration of air into the cellular tex- 
ture), although usually regarded as a sequel of the 
disease, is a frequent concomitant of the severe forms. Its 
production is mechanical, and occurs from the forcible 
compression of the air into the lungs, which is effected 
by the diaphragm and other expiratory muscles whilst 
an obstacle exists to the egress of the air. 

Atrophy (diminution in bulk) of a part of the lungs is 
a frequent complication of whooping-cough. It results 
from closure of one or more divisions of the bronchi, by 
which the ingress of air to a part of the lung is presented, 
and the space left unoccupied is filled up by the undue 
expansion of the adjoining cells. When the part thus 
rendered useless is considerable, the gravity of the com- 
plication is great. It may be detected by the diminished 
expansion of the space over the part, and by the absence 
of respiratory sounds. 

Bronchitis and broncho-pheumonia are, however, the 
most frequent and fatal lung complications of this dis- 
ease. Deaths from whooping-cough are almost exclusively 
due to these diseases. In both there are evidences of 
fever in the varying degrees of heat and dryness of the 



330 THE FAMILY PHYSICIAN 

skin and in the rapid pulse, Tboth during the paroxysm 
and in the intervals. The cough is more frequent and 
not always spasmodic, and the dyspnoea (difficulty of 
"breathing) is more permanent. 

The brain complications are convulsions and hydro- 
cephalus (a collection of water in the head). 

The occurrence of convulsions can not usually "be pre- 
dicted ; but if the child he teething or suffering from 
derangement of the bowels, if during the spasm the 
thumbs be drawn inward, and during the interval the 
discoloration of the face continues without lung compli- 
cation, and if there be a marked degree of exhaustion or 
oppression following the paroxysm, or the eyes be in- 
tolerant of light, convulsions should be anticipated. 

Hydrocephalus is so frequently a constitutional affec- 
tion that the relation of whooping-cough to it is rather 
that of an excitant of a previous predisposition. The 
signs are often obscure at first, but in many cases the 
occurrence of drowsiness, headache and starting during 
sleep, convulsions, heat of the skin, rapid pulse, intoler- 
ance of light and lessened mobility of the pupils, and in 
others the persistent disposition to vomiting on being 
moved, will indicate the occurrence of this most important 
complication. 

The complications with infantile remittent fever is 
most generally found when the latter disease prevails, 
and when there have been evidences for some weeks of 
a disordered state of the 'bowels. The tongue is coated, 
the breath foul, the evacuations disordered, and the 
bowels tender on pressure and swelled ; the patient does 
not recover health and strength, but, with or without in- 
troductory rigors, slowly exhibits signs of fever. Such 
cases are protracted in their recovery. 

The complication of exhaustion is most generally found 



AND GUIDE TO HEALTH. 331 

in children of weak constitutions, or in those who have 
been enfeebled by previous disease. In such, prostration 
is a marked feature, even during the catarrhal period, 
but when the spasm has fairly set in it is extreme after 
every paroxysm. The appetite is inadequate to sustain 
the system. 

TEEATMENT. 

A greater number of remedies has been prescribed 
in whooping-cough than in most other diseases — some 
with a view of " breaking up" or cutting short the 
disease. The practitioner might as well try to " break 
up" small-pox or measles as whooping-cough. Many 
of these articles, in their very nature contrary to each 
other, have been declared specifics, simply, I suppose, 
because they have been given in a case of whooping- 
cough, and the patient, in spite of the remedy and dis- 
ease, has recovered. 

Now, if there was no such thing as a disease " get- 
ting well itself," or, in other words, the system recovering, 
or no such principle as vis medicatrix naturce, a 
recovery after the administration of a certain article 
would prove much in its favor. But thanks to Him who 
planned the human system, for placing within it that 
curative and protective principle, without which I fear, 
notwithstanding the proud boasts of science, the poor 
frail system would never recover from any considerable 
pathological condition. But I fancy the poor child is 
not so fortunate in all cases ; its little stomach is crowded 
with improper drugs, warring with the disease against 
the feeble system, whose powers give way, and the poor 
little bud of promise is carried off. And the parents or 
friends try to content themselves by philosophically 
saying that they have tried " every thing they could hear 
of and all had failed." No wonder they failed; it 



332 THE FAMILY PHYSICIAN 

could not have withstood the drugs let alone the disease. 
Others leave the whole thing to nature, and for want of a 
little timely aid the child is lost. But the mortality in 
the former case is "by far the greatest, perhaps live to one. 
In the treatment of an uncomplicated case of whoop- 
ing-cough the chief aim should be to allay the spasm, 
and thus prevent complications which result from it, and 
reduce the disease as soon as possible to a common 
cough. The first object, then, to be attended to is to give 
the compound powder of rhubarb and potassa — rhubarb 
two drachms, bicarbonate of potassa one drachm ; mix 
them thoroughly together. The dose of this for a child 
two years old is one or two grains every two hours until 
it moves the bowels. (J. King's American Family Phy- 
sician.) This medicine is finely adapted to this com- 
plaint, for while it removes the fsecal matter and prevents 
its accumulation, it also neutralizes the excess of acid 
secretions in the stomach. The bowels must be very 
gently moved with this every second day at least, or, in 
other words, they must be kept regular by its use through 
the whole course of the disease. The child's diet is a 
matter of vast importance in this disease. If the stomach 
is overloaded the cough is worse ; if it contains any 
indigestible or irritating food the disease is greatly 
aggravated. For an infant the breast milk in small quan- 
tities and often is the best food ; but if the child does not 
nurse, the food should be restricted as far as possible to 
cooked milk, beef tea and meat — such as beef, mutton, 
game, fowls, fish, &c, but the fat hog meat, pork or 
bacon must not be used. Eggs, when the yolk has not 
been cooked hard, is also a good article of diet. But 
the same precaution must be used as to the quantity as 
is recommended in the case of the nursing infant, i. e., 
in small quantities ; and often good liberal feeding is 



AND GUIDE TO HEALTH. 333 

essentially necessary through the whole course of the 
disease. 

The clothing should be arranged to suit the tempera- 
ture of the atmosphere — dry and warm in cold weather 
— and the child must not be much exposed, unless the 
weather is pleasant, in which case the patient should 
have the benefit of fresh air and exercise. 

To allay the spasm, morphine stands deservedly high ; 
the use of it will generally reduce the symptoms to that 
of a common cough in a few days. But it must be used 
with much care and attention. The best preparation is 
to add one grain of the morphine to twelve teaspoonfuls 
of water and dissolve it. The dose for a child nnder one 
year old is about ten drops every four hours ; for a child 
two years old, one fourth of a teaspoonful ; for from three 
to five years old, one half teaspoonful. The effects of the 
medicine should be closely watched, and if these doses 
are not sufficient to produce a slight drowsiness on the 
child they should be carefulty increased until that effect 
is produced. This is a safe, harmless remedy if used 
with proper caution, and the most efficient known to the 
medical fraternity. It is recommended on the high 
authority of Dr. Edward Smith, of London, whose expe- 
rience in diseases of this class is as great, perhaps, as 
anj^ other man of the present day. 

Emetics may be employed with advantage in those 
simple cases of whooping-cough in which there is 
unusual difficulty in removing the "phlegm " or secretion 
from the bronchi, if it is excessive and impedes respira- 
tion. For this purpose the syrup of ipecac may be used, 
or what is very popular, hive syrup. But with the views 
which I entertain of the nature and treatment of this 
disease I do not think that emetics should be the chief 
remedies employed. 



334 THE FAMILY PHYSICIAN 

Liniment. — The neck, throat, chest and npper part of 
the spine should he rubbed once or twice a day with the 
following liniment: mix together oil of stillingia one 
ounce, oil of amber one ounce, oil of lobelia one quarter 
of an ounce, olive oil two ounces. For young children it 
will be necessary to use more of the olive oil in the pre- 
paration or it may irritate the skin too much ; this must 
be watched. And if in giving the solution of morphine 
too much drowsiness is produced, a few teaspoonfuls of 
warm, strong coffee will give relief ; but of this there can 
be no danger in giving the amount I have prescribed, 
and the medicine should not be withheld from the child 
through any fear of its effects. 

It is a curious fact that persons will use patent nos- 
trums freely themselves and on their children with no 
knowledge whatever of the composition of them, or the 
compounder either, but will refuse to use an article that 
the regular profession have tried and tested, and have 
no hesitancy whatever in recommending. Such, how- 
ever, is the case. The patent article is shrouded in mys- 
tery ; we are fond of the mysterious and lay hold of it. 

The complicated case of whooping-cough must be 
treated in view of the complications and according to 
their nature, the principles of which may be seen in 
the treatment of the several diseases with which it may 
be complicated, always keeping in view the principles 
laid down for the treatment of the simple forms of 
whooping-cough, and the sustaining principles laid down 
in this work. 



AiSTD GUIDE TO HEALTH. 335 



ERYSIPELAS 



This is an acute specific disease, characterized by a 
peculiar inflammation of the skin and a low type of fever. 
The inflammation has a great tendency to spread over 
the surface, to induce serious infiltration and suppuration, 
and to cause serious exudation between the cutis and the 
cuticle. The Germans call it die rose der rotJdauf, and 
the English Saint Anthony's fire. The disease may be 
caused by local irritation of the skin, still there seems to 
be some cause over and above that, as this cause does 
not necessarily produce it ; for some persons may be at 
times blistered, burned, cut, torn, or otherwise injured 
without exhibiting any indications of any such tendency, 
while others at times will take it from the slightest injury ; 
even a slight prick with a needle has caused the most 
dangerous cases. 

There are some facts which go far to show that this 
cause, or that some one or more of a number of concur- 
rent causes, may exist in the "individual," for it is well 
known that some persons are liable to suffer from repeated 
attacks of erysipelas, either with or without the 
slightest provocation. Above all it is equally clear that 
erysipelas often has an epidemic character, and it is still 
more common to find it haunting certain localites, 
thus exhibiting the features that are termed " endemic," 
so that in these cases its most effective cause would seem 
to be outside of the individual, viz. : in some external 
circumstance. 



336 THE FAMILY PHYSICIAN 

If we admit — as, indeed, we must do — the special lia- 
bility of some individuals or families to the occurrence 
of this disease, then the conditions underlying such lia- 
bility must be regarded as "predisposing causes" of 
erysipelas, and we must seek still further for the so- 
called "exciting cause" of the affection; this may 
commonly but not invariably be found in accidental or 
other injuries to the skin, such as exposure to cold or 
heat, to moisture, or physical abrasion. If we accept, on 
the other hand, the presence of a distinct morbific agent, 
either epidemic or endemic, as the efficient cause of 
erysipelas, then the constitutional state of the sufferer 
sinks into comparative unimportance, although we may 
still retain some belief in its action as a predisponent. 
The truth as to causation lies, most probably, not be- 
tween these two ideas, but in their combination ; and such 
conclusion is by no means at variance with the belief 
that sometimes the one and sometimes the other factor is 
the more influential. It niay be that either one may 
sometimes be so potent as per se to produce the disease. 

In addition to the " exciting causes " already men- 
tioned, viz. : under impressions upon the skin, we must 
enumerate errors in diet, and especially the taking of 
certain things, such as shell-fish or improperly smoked, 
dried, salted or otherwise " half preserved " meats. But 
by far the most important cause, acting from without, is 
the " poison," whatever may be its nature, which exists 
in one case and can be communicated to another, either 
by inoculation, simple contact, transmission through 
the air or by fomites. 

SYMPTOMS. 

Erysipelas is generally ushered in by a marked uneasi- 
ness of a not very definite character ; rigors, slight shiver- 



AXD GUIDE TO HEALTH. 337 

ing, or only a feeling of chilliness, may mark the onset 
of the malady. The symptoms are both general and 
local ; on the one hand there is fever, on the other definite 
structural change in the skin, mucous membrane, and it 
may be in the sub-cutaneous and sub-mucous tissues. 
Fever sometimes precedes the redness of the skin, and 
sometimes the local inflammation is first observed of a 
bright, shining, red color. 

It often happens that the patient feels well in the 
morning and at mid day, but toward evening is uneasy, 
passes a restless night, growing worse from hour to hour, 
and on the morning of the next day observes some red- 
ness of his nose or ear ; or, feeling better but not well on 
the second morning, he goes through a day of increasing 
discomfort, which becomes very considerable toward 
evening, passes a second night worse than the first, some- 
times accompanied by delirium, and the special pheno- 
mena of erysipelas appear on the third day. But their 
appearance may be delayed to even the fourth or fifth 
day from the onset of the symptoms. There is aching 
of the limbs, loss of appetite, thirst, nausea or vomiting, 
diarrhea, soreness of the throat, increased heat of the 
skin, and in fact all the signs of febrile disturbance. 
These symptoms are usually, but not always, present. 

On the appearance of the cutaneous inflammation there 
is no remission of these symptoms ; on the contrary, they 
are sometimes augmented in their intensity. The usual 
site for their development is some part of the head ; but 
they may appear in any other portion of the body. 
Local disease or injury of the skin, or even of the sub- 
cutaneous tissues, may determine the place of com- 
mencement. Usually the nose or the ear is the point at 
which the inflammation may first be seen ; it is generally 
seen to commence in close proximity to one of the pas- 



338 THE FAMILY PHYSICIAN 

sages through the skin, i. e., where the skin undergoes 
that transition which consists in its becoming what we 
term mncons membrane. 

To the patient the part affected feels hot and irritable, 
and npon touching it, sore, stinging and smarting. It is 
of red color and shining aspect, warmer and harder than 
the surrounding tissues, swollen, and as the disease ad- 
vances very tender to the touch. The redness extends 
from the spot first affected sometimes in all directions, 
but more commonly in one much more rapidly and widely 
than in another. It does not spread much on mucous 
membrane. Sometimes the amount of swelling is incon- 
siderable, at other times it is enormous, and the disfigure- 
ment is such that no one would recognize the features of 
the sufferer, nor for a moment think that they were 
features at all, or even parts of any human being. Such 
was the case in an attack the writer experienced in per- 
son about twenty-two years ago. It was in the face, and 
extended up the cheek and around one eye and one side 
of the nose. The appearance was hideous and really 
frightful. Well do I recollect the appearance of some 
timid friends when they saw me ; and well, too, do I 
recollect the agony I was in. The case was a severe one, 
and lasted for weeks. I only owe my recovery to a vigor- 
ous and powerful constitution. At that time so little was 
known about the treatment of this terrible disease that 
the physician — a good one, and a kind hearted man, to 
whom I shall ever feel grateful — Dr. Elijah McLean, of 
Washington, Mo., allowed nature to have her own course, 
and the great principle to which I have so often referred 
in this work, vis natures medicatrix, triumphed, and I 
was healed. 

About this time the disease prevailed to an alarming 
extent, both as- an epidemic and as an endemic, for it was, 



AND GUIDE TO HEALTH. 393 

particularly in Franklin county, Mo., mostly confined to 
the town of Union, the connty seat. The " antiphlogistic 
regimen " was actively tried, and the disease was fear- 
fully fatal. Eighty per cent, at least of the cases proved 
fatal. Again I feel inclined to thank the Doctor for his 
kindness in only giving me a little palliative treatment, 
and allowing my system at least to have a fair chance. 

TEEATMENT. 

Dr. J. Enssell Reynolds, in his excellent work, entitled 
" A System of Medicine," prefaces his remarks on the 
treatment of erysipelas with the following: "As I be- 
lieve that the class of cases which have been described 
in such manner as to justify the use of antiphlogistic 
treatment do not exist except in the histories of the past 
and the imaginations of the present, it appears to me 
unnecessary to say how much blood should be taken 
from the arm of a man ; provided, that he is found in a 
condition that we never met with." As to the treatment 
he says, further, "The general medical treatment of 
erysipelas resembles rather that of the adynamic (low) 
fevers than that of inflammations, even supposing that 
the latter should present occasionally what is called 
6 sthenic' form." Almost all the cases — so far as my 
own experience reaches — all that come under the care 
of the physician from the first, not only bear well, but 
are positively benefitted by the supporting and tonic 
treatment. The kind and degree of such treatment must 
be determined by, and proportionate to, the severity of 
the symptoms which have been already described. In 
some cases stimulants are required from the first, the 
conditions which necessitate their employment being 
identical with those which are common to that large 
group of diseases in which erysipelas finds its place-. 



340 • THE FAMILY PHYSICIAN 

When stimulants are not required at the onset, little or 
nothing is gained "by such use of salines, or any other 
general treatment which shall do more than maintain a 
normal amount of the secretions. Thus, in very mild 
cases, in persons of average health, one or two doses of 
the simplest saline aperient may be all that is requisite. 
When the disease is more severe, and exhibits a ten- 
dency to spread after the balance of secretion has been 
restored, the patient at the same time becoming restless 
and exhausted, the most efficient general treatment con- 
sists in the administration of bark, with ammonia, during 
the day, and an efficient but not heroic opiate at night. 
Should the adynamic symptoms increase, large quanti- 
ties of alcoholic stimulants are required, at short inter- 
vals ; and the amount that may be taken with advan- 
tage is as large as that which has been found useful in 
any of the specific fevers. 

The tincture of sesquichloride of iron of the London 
Pharmacopoeia is by far the most useful medicine that 
I know of in the treatment of this disease. So marked 
is its action that it has been thought by some to exert a 
" specific " influence in erysipelas ; but without asserting 
that it possesses such power, in the strict sense of the 
word "specific," it may be well to mention that its 
utility appears equally great in diphtheria, and, per- 
haps, still greater in cases of diphtheroid sore throat. 
The essential condition of its success is its administra- 
tion in large and quickly repeated doses. It has often 
happened that disappointment has arisen in the use of 
the tincture of iron, but in most of these instances the 
tincture has been given in doses of ten or fifteen minims 
three times daily; such doses are certainly useless. 
But when the tincture is given in doses of forty minims 
(drops), or even more, every four hours, the results have 



AND GUIDE TO HEALTH. 341 

usually "been most favorable. The most convenient form 
for its administration is a mixture containing in each 
dose forty minims of the tincture with an equal quantity 
of chloric ether and glycerine, diluted with an ounce and 
a half of water. The effects of this medicine may "be 
seen sometimes after the first, often after the second, 
dose : the local inflammation ceases to extend ; the 
inflamed part becomes paler, less tender, less swollen ; 
the feeling of exhaustion is diminished, and with it such 
symptoms of exhaustion as exaggerated frequency of 
pulse and dry brown tongue ; the temperature falls, and 
sleep frequently ensues. As soon as such changes take 
place the quantity of the tincture may be reduced. It 
is not, however, safe to trust to this medicine alone ; alco- 
holic stimulants are often required at the same time. 

In the local treatment of erysipelas two things are to 
be strenuously avoided — the exposure of the skin to 
variations of temperature, and the other any thing that 
shall interrupt its natural function. Among the former 
are included exposure to drafts and to the chilling 
effects of wet applications ; among the latter the cover- 
ing of the skin with any oily matters, ointments, &c. It 
has occurred to me frequently to see erysipelas spread- 
ing rapidly under the use of " cooling lotions," and to 
see it arrested by their discontinuance, and the applica- 
tion of simple dry flour, violet powder, or oxyde of zinc. 

The spread of the inflammation can often be prevented 
by the application of nitrate of silver — marking a line 
around the edge with a strong solution of it with a 
camel's hair pencil. This should always be attempted ; 
too much importance, however, must not be attached to 
it and other treatment neglected. 

The danger or "road to death" in erysipelas lies in 
three directions : first, by exhaustion ; second, by impli- 



342 THE FAMILY PHYSICIAN 

cation of the brain ; third, by obstruction of respiration. 
The first is guarded by sustaining the system with 
stimulants and nutrients ; the second, when it occurs, or 
when the brain or membrane is affected, by ice to the 
head and warm foot baths ; the third, when the fauces or 
glottis is so swollen as to threaten life, laryngotomy or 
tracheotomy must be performed. 

When pus is known to exist, even in small quantities, 
in the neighborhood of an important organ, such as the 
eye or glottis, an incision must be made for its evacua- 
tion. When it exists in larger quantities, under the skin 
of limbs or about joints or glands, the same plan should 
be adopted ; free incisions are necessary. 

Good feeding, fresh air and quiet are necessary in the 
treatment of erysipelas. 

Some cases are so mild as scarcely to require any 
treatment, but the disease may generally be reckoned 
among the troublesome and dangerous, particularly if 
treated on the lowering system. 



A^D GUIDE TO HEALTH. 343 



Diseases of the Circulatory System. 



There are several valuable rules that the researches of 
able men have established for guidance in disease of the 

HEAET. 

1. "In health the cardiac dullness, on percussion, meas- 
ures, immediately below the nipple, two inches across, 
and the extent of the dullness beyond this measurement 
commonly indicates either the increased size of the organ 
or undue distension of the pericardium." 

2. In health the apex of the heart may be felt and seen 
to strike the chest between the fifth and sixth ribs, im- 
mediately below and a little to the inside of the left nip- 
ple. Any variations that may exist in the position of 
the apex are indications of disease, either of the heart 
itself or of the parts around it. 

3. A friction murmur, synchronous with the heart's 
movements, indicates pericardial or exo-pericardial exu- 
dation. 

4. A bellows murmur with the first sound, heard loud- 
est over the apex, indicates mitral insufficiency. 

5. A bellows murmur with the second sound, heard 
loudest at the base, indicates aortic insufficiency. 

6. A murmur with the second sound, loudest at the 
apex, is very rare ; but when present it indicates — first, 
aortic disease, the murmur being propagated downward 
to the apex ; or, second, roughened auracular surface of 



344 THE FAMILY PHYSICIAN 

the mitral valves : or, third, mitral obstruction, which is 
almost always associated with insufficiency when the 
murmur is double or occupies the period of both cardia 
sounds. 

7. A murmur with the first sound, loudest at the base 
and propagated in the direction of the large arteries, is 
more common. It may depend — first, on an altered con- 
dition of the blood, as in anaemia ; or, second, on dilata- 
tion or disease of the aorta itself; or, third, on stricture 
of the aortic orifice or disease of the aortic valves, in 
which case there is almost always insufficiency also, and 
then the murmur is double, or occupies the period of 
both sounds. 

8. Hypertrophy of the heart may exist independent of 
valvular disease, but this is very rare. In the vast ma- 
jority of cases it is the left ventricle which is affected, 
and in connection with mitral or aortic disease. In the 
former case the hypertrophy is uniform, with rounding 
of the apex ; in the latter there is dilated hypertrophy, 
with elongation of the apex. 

Attention to these rules alone will, in a great majority 
of cases, enable you to arrive with precision at the na- 
ture of the lesion present. In cases in which there may 
be any doubt you will derive further assistance from our 
observation of the concomitant symptoms, such as — first, 
the nature of the pulse at the wrist ; second, the nature 
of the pulmonarj^ or cerebral derangement. Thus, as a 
general rule, but one on which you must not place too 
much confidence, the pulse is soft or irregular in mitral 
disease, but hard, jerking or irregular in aortic disease. 
Again, it has been observed that cerebral symptoms are 
more common and urgent in aortic disease, and pulmon- 
ary symptoms more common and urgent in mitral disease. 

I have purposely said nothing now of the disease of 



AKD GUIDE TO HEALTH. 345 

the right side of the heart, and of a few other rare dis- 
ordered conditions of the organ, because I am convinced 
that an appreciation of the rules above given is the best 
method of enabling you to comprehend and easily detect 
any exceptional cases which may arise. 

To recapitulate : You have to determine — first, by 
percussion, whether the heart be of its normal size or 
not ; second, whether an abnormal murmur does or does 
not exist ; third, if it be present, whether it accompanies 
the first or second sound of the heart ; and, fourth, in 
what place and in what direction the murmur is heard 
loudest. These points ascertained, the conclusion follows 
from the rules previously given. 

Nothing but percussing the cardia with your own 
hands and carefully listening to the sounds with your 
own ears can be of the slightest service in making a cor- 
rect diagnosis in heart disease. By carefully observing 
and studying the above rules any one with ordinary 
judgment can asertain the true condition of the diseases 
of the heart, and I shall give no further symptoms. 

VALVULAR AND ORGANIC DISEASES OF THE 

HEART. 

The lesions producing valvular diseases of the heart 
are various, and may be referred to mechanical violence, 
to the effects of exudation, acute or chronic, to depositions 
of fibrin, and to the different forms of degeneration of 
texture. But, however occasioned, they all tend to pro- 
duce subsequent changes in the texture and vital actions 
of the heart itself, and above all, hypertrophy and fatty 
degenerations of its muscular walls, with increased, 
diminished, or irregular contractions of its cavities. It 
is with these latter that the physician has principally to 



346 THE FAMILY PHYSICIAN 

do, although a knowledge of the former is essential to a 
correct appreciation and proper treatment of every indi- 
vidual case. 

Meelianical injuries not unfrequently occasion sudden 
disease or rupture of the valves, separating their at- 
tachments and causing subsequent adhesions and fibrin- 
ous depositions. Great muscular exertion has also 
occasioned similar results. 

Exudations into or on the surface of the valves, con- 
stituting the endo-carditis of systematic writers, is a 
common cause of valvular disease. 

Deposition of fibrin from the blood may occur on the 
valves in consequence of laceration or of exudation, but 
sometimes, as far as can be ascertained, without organic 
lesion. When the blood abounds with fibrin, as especially 
occurs in acute rheumatism, such deposits may take place 
on the valves themselves without any previous lesion of 
them, an occurrence which would seem to explain the 
relation between rheumatic and cardiac disorders. 

Degeneration of the valves may occur in various ways, 
and in its nature be albuminous, fatty, or mineral. Thus 
the thickening and indurations owing to chronic exuda- 
tion may assume a density equal to ligament or fibro- 
cartilage ; or, on the other hand, they may soften, 
undergo fatty degeneration, and at length ulcerate, 
forming one or more perforations through the membran- 
ous portion of the valve. 

The immediate result of all these different lesions is, 
that the valves being incompetent and not closing per- 
fectly; the blood regurgitates back into the ventricles or 
auricles at each systole or diastole, according to the 
valve affected, or, if there be contractions and obstruc- 
tions at the orifice, it is propelled forward with difficulty. 
In either case increased muscular effort is required to 



AND GUIDE TO HEALTH. 347 

carry on the circulation, and the result is the greater or 
less enlargement of the heart, or hypertrophy. 

Hypertrophy of the heart may arise from several 
causes, but by far the most common is disease in one or 
more of its valves. In this case it follows the certain law 
of increased growth : parts subjected to unusual exertion 
or increase of function, as the blacksmith's arm or the 
muscles on the leg of the " pretty danseuse," increase 
in bulk. 

Fatty degenerations of tlie heart. The heart may be 
loaded, and even more or less infiltrated, with adipose 
tissue, producing one form of fatty degeneration. By far 
the most important form, however, is the lesion. There 
can be no doubt that the fibro-albuminous substance 
constituting flesh is capable of undergoing a transforma- 
tion into fat. Of the exact chemical nature of that trans- 
formation we know but little ; it may not only be observed 
in the dead body, but may be produced artificially by 
exposing muscle to a running stream of water, whereby 
it is changed into adipocere. It may occur as a sequela 
of every form of cardiac disease, but especially when the 
aortic valves are affected, as well as from a modification 
in the general condition of the system leading to fatty 
degeneration of a number of other organs. 

Myocarditis, or true inflammation of the substance of 
the heart, is one of the rarest organic diseases known. 

TEEATMENT OF VALVTTLAE AND OEGANIC DISEASES OF 

THE HEAET. 

That the various lesions of the valves are susceptible 
of being removed by medicines is one of those fallacies 
the advance of science has expelled. All that the prac- 
titioner can hope to accomplish is to modify, and if pos- 
sible check, those resulting phenomena from which real 



348 THE FAMILY PHYSICIAN 

danger is to Ibe apprehended. The notion is very general 
that simply because the pnlse is strong it is the mission 
of the practitioner to make it weak ; that "because the 
heart acts violently it ought to be made to beat quietly 
by lowering the system. 

We have seen that valvular disease leads to dilated 
hypertrophy ; this is accompanied by excessive action, 
and a strong, jerking, hard pulse. But the strong pulse 
and enlarged ventricle in the one case is a wise provision 
of nature, set up to counterbalance the otherwise fatal 
consequences of the valvular obstruction; it is that 
" marvelous power whereby it protects itself against dis- 
ease." And the violent action of the heart in the other 
is a proof of weakness rather than of strength, and in- 
stead of being lessened by bleeding and antiphlogistics, 
requires for its removal tonics, nutrients and calmatives. 

"What, then, we have principally to attend to in valvu- 
lar disease of the heart is, to do all in our power to sup- 
port the normal strength of the economy and avoid 
agitating the patient, instead of lowering the pulse or 
giving mercury, under the idea that thereby we are 
putting down an inflammation or causing absorption of 
the exudation. Pain, agina and paroxysmal attacks 
may be relieved by the cautious use of morphine or 
digitalis, used as palliatives. The grand and prominent 
feature to be remembered is to build up and sustain the 
system ; use a good, nutritious diet ; avoid tea, coffee and 
tobacco ; use such tonics as tincture of Peruvian bark or 
quinine ; keep the bowels in a healthy, soluble condition, 
or at least have one operation every day ; avoid all kinds 
of excitement and take exercise in the open air. 

FUNCTIONAL DISORDERS OF THE HEART. 

What are called functional disorders of the heart are 
in fact, only symptoms of obscure organic diseases — or 



AND GUIDE TO HEALTH. 349 

indigestion, or of weakness of the general system from 
alteration of the blood, or other canse. They assnme 
three princpal forms : First, angina pectoris, or spasm of 
the muscular walls of the heart, causing excruciating 
pain and a feeling of sinking difficult to describe. It is 
generally induced by exertion. It may accompany or- 
ganic disease of- the organ, and it has been frequently 
observed in connection with fatty heart and calcareous 
degeneration of the coronary valve. Second, in chlorosis 
and the anaemia of young women ; these are palpitations 
with a tendency to syncope, accompanied by a blowing 
murmur at the base. The cause of this is very obscure ; 
is said by some to be arterial and by others venous. 
Similar palpitations, often with a small heart, occur in 
young men who follow sedentary pursuits, especially 
students of the learned professions. Their appetite is 
generally defective, the body weak and indisposed to 
exertion, the mind and nervous system irritable, and the 
sleep prevented by the excessive action of an uneasy 
sensation attributed to the heart. 

TREATMENT. 

The treatment in all of these cases is, when it is 
dependent on weakness, to increase the vigor of the 
constitution by nutrients, proper exercise and the ad- 
ministration of iron. In chlorosis, more especially, the 
different preparations of iron are beneficial. In young 
men, regulated exercise, suspension from study, attention 
to diet, and especially removing the attention from the 
heart at night by cheerful conversation or interesting 
light reading, are the most useful means of removing the 
disorder. In all cases the concomitant derangements 
must be studied and, if possible, removed, such as 
amenorrhea, hemorrhoids, spermatorrhea, dyspepsia, &c. 



350 THE FAMILY PHYSICIAN 



COIGESTIOI OF THE BKAiN. 



1, APOPLECTIC FOEM ; 2, CONVULSIVE FOEM ; 3, DELIRIUM ; 
AND, 4, FEBRILE FOEM. 

Under the name congestion of the brain I have in- 
cluded fonr forms somewhat different in their character. 
In one of these forms the case is described as an " apo- 
plectic" or a paralytic stroke, in another a seizure of 
" convulsions," in a third " delirium," and in the fourth 
as a feverish attack or "brain fever." Patients taken 
with symptoms of disturbance in any of these forms 
often die ; and, upon post mortem examination, there 
may be but one departure from healthy appearance of 
the brain, viz. : congestion. 

It will be convenient to describe first the premonitory 
symptoms of cerebral congestion, viz. : those which are 
or may be common to its several forms ; then to detail, 
under four distinct heads, the developed symptoms, with 
their modes of termination in recovery ; and, lastly, to 
describe again generally those which are fatal and into 
which any one of the four varieties may pass by a rapid 
or gradual progress. 

SYMPTOMS — A PEEMONITOEY. 

" There is often a mixture of two classes of symptoms," 
says Dr. Reynolds : " those which indicate over action 
and the reverse ; sometimes the two exist, at other times 



AND GUIDE TO HEALTH. 351 

they alternate ; in one case the former gronp is predomi- 
nant, in another the latter ; whereas in a few all the 
symptoms tell in a direction either of inaction or nndne 
excitement. It is possible sometimes to foretell from the 
nature of those symptoms the form which it is most 
likely that the disease will hereafter assnme, but such 
forecast is uncertain in all cases, and useful in only a 
yery small proportion. 

" The mind is changed in such manner that there is 
diminished intellectual power ; thought becomes confused 
and memory treacherous ; the individual maybe irritable, 
worried, fanciful, peevish or depressed ; sleepy, and es- 
pecially so after meals ; at times indifferent and sluggish ; 
he complains that he 'can not think,' and the forced 
effort to do so makes him worse ; he talks at random, 
using wrong words, sometimes noticing his blunders, cor- 
recting them and expressing his annoyance ; sometimes 
not observing that he was wrong and being greatly an- 
noyed at any one who should attempt to set him right. 
He is usually worse after being in a recumbent position 
or posture, and often sleeps ; his sleep is heavy and dis- 
turbed by dreams and nightmare ; sometimes there is 
transient delirium ; one person is mistaken for another ; 
the past and the present are curiously intermixed and 
the conversation is like that of a dream, which goes on 
while the patient is awake, but from which he may be 
awakened still further by a loud voice or any other 
strong appeal to the senses." 

The senses are dull, hearing is defective, and there are 
"rumbling noises in the head;" the sight is dim, and 
" black specks " appear before the eyes ; sometimes 
diplopia (double sightedness, when two objects are seen 
at once — you look at the moon you see two moons) is 
present ; there is giddiness, and a feeling of fullness and 



352 THE FAMILY PHYSIQIAN 

oppression in the head, with " stupid headache " — made 
worse by lying down. There is rarely pain in the head, 
but, as the patient says, a " confused, uncomfortable 
feeling." The limbs feel heavy, and there is often numb- 
ness, or "pins and needles" in the toes and fingers. 
These sensations come and go, but between the period of 
their recurrence there is a sense of general discomfort, 
which it is often quite impossible for the patient to 
describe. Often it is that of "oppression about the 
breathing ;" and great difficulty from this source is expe- 
rienced in walking up stairs, or up hill, or even a little 
more quickly than usual on level ground. Sometimes 
" feelings of faintness " are complained of, and with them 
nausea and increased vertigo. 

The power of movement is diminished, and with it, 
more notably, the readiness of action. The limbs are 
dragged along sleepily or sluggishly ; the step loses its 
elasticity, is shorter than in health ; the general bearing 
is changed; and sometimes, but rarely, alterations in 
power and activity are observed on one side of the body 
more particularly than on the other. The patient simply 
leans forward, and appears weak and lethargic ; or he 
may lean on one side, hold one shoulder half an inch or 
an inch higher than the other when standing, and when 
sitting collapse, as it were, on the lower side. 

There are other symptoms than those of direct change 
in the nervous functions, such as redness, and often 
dusky redness of the lips, eyes, face and scalp. The 
head is hotter than the cheeks, the jugular veins are 
distended, and the neck appears thick. On stooping the 
veins of the forehead are too full, and the beat of the 
carotids is too distinct. The pulse is slow and labored, 
or quick and feeble ; the tongue is foul ; the urine small 
in quantity ; the bowels are confined, and the extremities 



AND GUIDE TO HEALTH. 353 

cold. The heart may be found dilated, and there may 
be tricuspid regurgitation, shown by the pulsation of 
the jugulars, and systolic murmur at the ensiform car- 
tilage. {See article on vascular system.) 

These premonitory symptoms may exist for variable 
periods of time, may appear and disappear, or may 
gradually increase and pass into one or another form of 
malady already hinted at, but now to be described. 

DEVELOPED SYMPTOMS — 1, APOPLECTIC FOEM. 

The attack usually takes place during some muscular 
exertion, such as lifting a heavy weight, blowing the 
nose, coughing, sneezing, straining at stool, or stooping 
to pick up something. Sometimes it can not be traced 
to any one of them, but it rarely occurs during sleep ; 
patients do not wake up and find themselves in a state 
of what is called "congestive apoplexy." They are more 
commonly doing their ordinary work, or trying to do a 
little more than they are able to accomplish, when the 
attack is made. Consciousness, sensation and power of 
motion seem to be lost, and the patient is said to have 
an " apoplectic fit ;" but these faculties are not alto- 
gether lost, or if they are, it is for a few moments only. 

The mind is not in complete abeyance. There are in- 
dications that the patient knows, though but imperfectly, 
what is said to him ; he makes some attempts to respond 
to questions, and to do what he is asked to do. He 
starts at a loud and sudden noise, looks around him, and 
gives signs of annoyance when he is disturbed. If at the 
moment of seizure he should appear to be in profound 
coma, this coma is of short, almost momentary, duration, 
and soon there are signs of returning consciousness; there 

is confusion of thought, bewilderment, and dullness of 
23 



354 THE FAMILY PHYSICIAN 

apprehension, passing sometimes into a mild delirium, 
"but more often into a heavy sleep. 

The senses, obtuse for a moment, are rapidly restored 
to a certain point. The patient shrinks from strong 
light, groans when pinched, starts when spoken to, but 
yet takes little or no notice of ordinary impressions. The 
power of motion is so diminished that the patient falls 
down, and the limbs when raised fall heavily. There is 
no stertor in the breathing. The speech is clumsy, the 
words are clipped, and wrong words are used ; but this 
is for a short time only. 

The pulse at the moment of attack is sometimes sus- 
pended at the wrist, and the breathing is arrested ; but 
soon the pulse is felt to be heavy and labored, and the 
respiration becomes tumultuous ; and again in a few 
seconds both go on as they did before. The vascular 
fullness is greatly increased. 

The symptoms of a first attack generally abate in an 
hour or less ; sometimes they last much longer. Upon 
each succeeding attack the symptoms last longer gener- 
ally; fresh attacks supervene, each one leaving the 
patient lower and lower. 

The apoplectic form of cerebral congestion is most 
common in advanced life. 

THE CONVULSIVE EOEM. 

The paroxysms that occur have the general features of 
epilepsy, but they differ from the attacks of that disease 
in their general history and mode of onset. 

Congestive convulsions may occur at any period of 
life, but they are most frequently met with at the time 
of full maturity, or when that stage is past. These are 
usually the premonitory signs of congestion, but they 



AND GUIDE TO HEALTH. 355 

may be very slight. The patient may be seized during 
sleep, or while making some unaccustomed effort. 

Much discomfort precedes an attack for a few seconds, 
minutes, or it may be hours. A tight cravat worn while 
making some undue exertion, a sudden alarm, or an 
indigestible meal rapidly swallowed, may be the imme- 
diate antecedent. The patient, more or less suddenly, 
becomes confused, then apparently half unconscious, 
makes some unintelligible sounds, turns red and then 
blue in the face, staggers for support, looks round him 
wildly or imploringly, and then sits down or falls down 
convulsed, and a paroxysm of an epileptic character 
supervenes. From this he recovers partially, exhibiting 
great confusion of mind, headache, muscular feebleness, 
and sometimes partial paralysis of one side. 

The attack is sometimes followed by quasi-maniacal 
excitement, lasting from half to three or four hours, after 
which the patient becomes exhausted, and falls into a, 
heavy sleep. 

From this state he may recover, or during sleep a* 
second or third attack of convulsions may come on. 

THE DELIEIUM FOEM. 

Delirium may be the most marked symptom of con- 
gestion of the brain in certain cases. The attack may 
come on suddenly, may be induced by a fall or fright ; 
but when occurring spontaneously is first observed 
toward evening. Sometimes the attack is preceded by 
"depression of spirits;" the patient after some hours,, 
or even days of taciturnity, becomes cheerful or gay and. 
hilarious ; he talks loudly and incoherently, but rarely 
exhibits any violence. He gets out of bad, wanders 
about his room, opens drawers, puts on his dress, and is 
bent upon doing something he can not explain, or which, 



356 THE FAMILY PHYSICIAN 

if expressed in words, is unnecessary and absurd. He 
is under a delusion of no fixed character; and can 
usually be directed and managed without much difficulty. 

The patient may complain of pain in the head, or an 
uneasy sensation in the limbs ; and there may be 
twitching of the muscles, or weakness of the extremities. 

Durand Fardel states that it is common to find a mu- 
cous secretion, clear and viscid, produced on the eyelids, 
or in the interior of the mouth, and sometimes running 
over the whole face. 

THE FEBEILE EOEM. 

In the earlier periods of life, and especially in infancy 
and childhood, congestion of the brain may occur with 
marked elevation of temperature, dry skin, restlessness 
and thirst. The head is unduly hot, the cheeks and con- 
junctiva are flushed, while the extremities are cold ; the 
mental faculties are obscured, and the sleep is broken 
by dreams or transient and mild delirium. Usually there 
has been some distinct cause for such disturbances ; there 
is no marked prostration, no initial rigor. The patient 
usually recovers speedily. Recovery is, however, not 
always observed, the distress may persist, there may be, 
alternately, convulsions and delirium, or there may be 
the changes from over excitement to drowsiness — the 
latter gradually becoming relatively more marked, until 
the patient passes into a state of stupor from which he 
may never rally. 

Finally, under whatever form congestion of the brain 
may occur primarily, its tendency, unless speedily 
recovered from, is to produce a condition of torpor and 
inactivity. The mind becomes a blank ; there is some- 
times profound coma, stertorous breathing, and involun- 
tary evacuations of both the bladder and rectum ; sensi- 



AND GUIDE TO HEALTH. 357 

bility, both general and special, is lost, and voluntary 
muscular power reduced to a minimum. Convulsions may 
occasionally disturb the calm, or there may be fitful and 
momentary muttering of unintelligible sounds, but 
usually, in this latter stage, the patient lies quietly, with 
labored pulse and breathing, and with flickering con- 
tractions of the muscles of the limbs until he dies. 

TREATMENT. 

Bleeding has heretofore been universally recommended 
for congestion of the brain, but as there are two distinct 
classes of patients, one plethoric, and the other low, the 
pulse small, feeble and irregular, I do not know how the 
treatment is to be reconciled, even with common sense. 
Late writers, more conservative, only recommend blood 
letting in the case of the plethoric. Dr. Reynolds, in his 
excellent " System of Medicine," so wedded has he been 
to the popular theory that he, with all his good sense 
and knowledge of the true principles of practice, goes 
on to recommend bleeding, to the extent of eight or ten 
ounces, in the plethoric form. But, as if awakened to 
common sense by the utterance of such pernicious lan- 
guage, he says, " No man at the present day would think 
of bleeding from the arm." But he spoils this sensible 
language by continuing and recommending leeches and 
cupping to the back of the neck to the extent of three 
or four ounces. 

For the proper treatment of congestion of the brain it 
is proper to raise the head, to apply cold water or ice to 
the forehead, and to place the feet and hands in hot 
baths. If the stomach be overloaded, an emetic of a 
tablespoonful of mustard in half a pint or less of warm 
water, or of twenty grains of ipecac in warm water, 
should be given — one fourth of a pint may be given at 



358 THE FAMILY PHYSICIAN 

once — and often with the discharge from the stomach the 
symptoms pass away. This is especially useful when 
the attack has followed a full but hastily taken meal. 
It is of great importance to empty the rectum, and the 
most efficient way of doing this is by an injection of 
warm water. 

When the tendency to cerebral congestion is noticed, 
rather than any marked symptoms of its presence to a 
high degree, the secretions must be carefully regulated, 
and among them one of the most important is the 
urinary. Many cases of threatening aspect are to be 
relieved by saline diuretics; and "I have known a copious 
now," says Dr. Reynolds, " of urine to be followed by 
the removal of symptoms which had existed in spite of 
free purgation and other treatment." There are many 
cases occurring in advanced life in which the congestion 
is of only momentary duration, after which the patient 
is bewildered and pale, his skin cool and moist, and his 
pulse feeble. Under such circumstances the cautious 
administration of alcohol is called for, and of this wine 
is most useful. 

It is well, however, to give carbonate of potash or soda, 
as there is always considerable acidity of the stomach ; 
and the discharge of flatus by the mouth, which results 
from such administration, is often followed by a com- 
plete remission of the symptoms. 

As precautionary measures, quiet of the mind and 
gentle exercise of body, with the careful avoidance of 
either fatigue, sudden change of posture or strain, should 
be enjoined ; and much relief may be obtained by insur- 
ing a position during sleep which shall prevent not only 
the head, but the head and shoulders from sinking 
down to the level of the body. This may be obtained by 
a simple contrivance placed under the bed or mattress 



AND GUIDE TO HEALTH. 359 

upon which the patient lies, such an arrangement being 
much better than a mass of pillows, which shift their 
places and often maintain the head in a condition of un- 
due heat. 

The word apoplexy has been used in two different 
senses. By some authors it has been employed to de- 
note a group of symptoms, such as we have given above 
under the head of "congestion;" but for these symp- 
toms we find congestion the better word, as it describes 
a condition — an anatomical condition. Other authors 
have applied the term apoplexy to an anatomical con- 
dition — cerebral hemorrhage. The term does not describe 
the condition, hence we will dispense with the use of it 
altogether, and use cerebral hemorrhage as a name alto- 
gether more suitable. The fact is, apoplexy has been 
and is applied to entirely too wide a range of diseases ; 
its range is almost as wide as the term " nervous " or 
" hysteria." Anything that seems to "surprise the brain" 
(as a lexicographer says in his definition of apoplexy) 
and produce insensibility is termed apoplexy. It matters 
not whether it is an effusion of blood, or a pressure upon 
the brain by congestion of blood vessels, a drunk, sun- 
stroke, poisoned by opiun (using it, as is the custom now, 
for the wicked purpose of intoxication), from uraemia, or 
the patient may be suffering from an abscess in the brain, 
or a condition of the nerves called " nervous apoplexy," 
or he may have received some injury on the head from a 
blow or fall ; or he may have a clot of blood in the ports 
varolii, or an epileptic fit, or a rupture of a cerebral 
aneurism. Any of these things produce " surprise of the 
brain," but it seems great folly to call them all by one 
name. 



360 THE FAMILY PHYSICIAN 

SUNSTROKE— INSOLATION. 

A disease of the nervous system, excited by heat, some- 
times following exposure to the direct rays of the sun, 
particularly when to heat is added the pressure of tight 
and unsuitable clothing ; more frequently occurring when 
the above conditions are combined with exhaustion. 

The history of this disease shows us that it has been 
known and recognized as a dangerous disease from early 
times. Fatal examples of it are recorded by the sacred 
writers, which have been referred to by most modern 
authors who have written on the subj ect. It is worthy 
of note that one of the blessings promised to those who 
shall be partakers of the better life that is to come is, 
that Hhe sun shall not light upon them nor anyheaV — 
a promise full of meaning to the inhabitants of the dry 
and thirsty land to whom it was first made. 

SYMPTOMS. 

Sunstroke or insolation has been divided by Dr. More- 
head into three varieties — the cardiac, the cerebro-spinal, 
and the mixed. In the present state of knowledge this 
classification is useful, and it certainly is founded on 
correct pathology. 

In the cardiac variety the patient falls, gasps, and in 
some severe cases expires before there is time to do much 
for his recovery, death taking place by syncope. 

In the so-called cerebro-spinal cases premonitory 
symptoms generally give notice of the coming danger ; 
these are extreme heat, dryness of skin, the skin sting- 
ing, giddiness, congestion of the eyes, extreme debility, 
nausea, and a frequent desire to micturate. 

The symptoms in the mixed form partake of both 
varieties, and death is brought about partly by syncope 
and partly by coma. 



AND GUIDE TO HEALTH. 361 

TREATMENT. 

Dr. W. C. Maclean remarks that " in the days when 
insolation was commonly mistaken for cerebral apoplexy 
the lancet was usually the first resonrce. The mortality 
even now, under a mode of treatment more in accordance 
with sound pathology, is often exceedingly high; Ibnt 
when blood letting was the the rnle recovery was the rare 
exception." The Dr. proceeds to give several cases where 
bleeding was resorted to and the cases proved fatal, one 
at least of which would have evidently recovered had he 
been let alone ; but the crimson fluid of life was ruth- 
lessly taken from him and death claimed him as a prize 
for the violation of the laws of life and health. 

At the earliest possible moment let the sufferer be 
carried to the nearest shade, stripped and assiduously 
douched with cold water over head, neck and chest. If 
tliis be effectually and quickly done, the powerful im- 
pression on the cutaneous nerves will soon re-establish 
respiration, at first by gasps and catches, soon in a more 
regular and tranquil manner. It will also reduce the 
heat of the skin. It may require to be done again and 
again. 

The patient should be encouraged to drink water freely, 
and if vomiting follows, this will often aid in relieving 
the congestion of the lungs. When the skin is cold and 
clammy and the respiration sighing, we must limit the 
use of the douche to the face and chest. When the heat 
of the skin is excessive we may use ice and give an in- 
jection of ice water. If sensibility be not restored and 
maintained by the douche, a blister may be applied to 
the back of the neck. We should also apply ammonia, 
"hartshorn" with the usual caution, to the nostrils. 

Chloroform is now being recommended by Dr. Maclean 
to be inhaled. He gets the suggestion from Dr. Barclay 



362 THE FAMILY PHYSICIAN 

These are both eminent physicians, and of course excel- 
lent authority. Dr. Maclean says, after speaking of 
having saved a number of lives in India by its use : " Dr. 
Barclay, in like manner, found chloroform inhalations 
useful in the convulsive form of the disease attended 
with extreme nervous irritability, a class of cases in 
which he adds the douche is inadmissible from the agony 
it occasions. In some instances life was saved by this 
remedy." It must not be forgotten that the patient must 
be well sustained, and a judicious use of stimulants must 
not be neglected. 

Persistent headache is one of the most common sequels 
to sunstroke. For this the use of the iodide of potassium 
is recommended ; but it is said that this troublesome 
sequel is seldom, if ever, gotten rid of without a journey 
to a colder climate. 



A^D GUIDE TO HEALTH. 363 



INFLAMMATION OF THE BRAIN. 

CEREBEITIS. 



It is scarcely possible for us to tell inflammation of the 
brain — cerebritis — from inflammation of the membrane 
around the brain — meningitis. Fortunately, however, it 
is of very little, if any, practical importance, as the two 
affections are almost always combined ; and if they were 
not, if judicious treatment be given for one, it will not be 
far out of the way for the other. 

Inflammation of the brain is a morbid process which 
gives rise to more or less complicated phenomena during 
life, while after death traces of its powers are to be 
detected. 

SYMPTOMS. 

The chief and most common early indications of 
encephalitis, or acute inflammation of the brain and its 
membranes are, fever, nausea and vomiting, acute head- 
ache, frequent and irregular pulse, bowels generally con- 
stipated, impatience of light and sound, watchfulness, a 
look of oppression, suffusion of the eyes, confusion of 
thought, and even delirium. 

At the end of from twelve hours to two days, the 
second stage of the complaint sets in — the period of col- 
lapse. The patient falls into a state of stupor ; his arti- 
culation gets difficult or indistinct ; his vision and hearing 
become dull ; the pupil, from having been contracted to 



364 THE FAMILY PHYSICIAN 

a pin's point, becomes dilated ; there may Ibe squinting 
and paralysis of the muscles of the eyelids ; there are 
frequent twitchings of the muscles ; the countenance is 
ghastly ; sordes form on the gums and teeth ; the "body 
is covered with cold sweats ; the sphincters relax ; and 
there is a few convulsive paroxysms, paralysis and pro- 
found coma, which usually soon end in death. Occa- 
sionally the first symptom that attracts attention is a 
sudden attack of convulsion, in some cases occurring 
without any previous illness, sometimes preceded for a 
few days by headache and slight complaints which have 
passed unnoticed. The convulsion is generally long and 
severe ; it may be followed immediately by coma, which 
in a few days is fatal, or it may recur frequently at short 
intervals and pass into coma at the end of twenty -four 
hours. Dr. Watson thinks that when nausea and vomit- 
ing are the earliest symptoms the inflammation has had 
its origin in the cerebral pulp — the substance of the brain ; 
and that when the attack commences with a convulsion, 
the inflammation has commenced in the pia mater or the 
arachnoid." The convulsions are thus caused by centric 
action. The disease may terminate fatally in a few hours 
or it many continue and the patient struggle on for weeks. 
Fortunately the disease is of rare occurrence. Plethoric 
persons and those who have short necks are said to be 
more subject to it ; this, I think, is extremely doubtful, 
so much so, in my mind, that I would place no reliance 
upon it whatever ; it is like a thousand other things that 
have been assumed in the medical science. 

TKEATMENT. 

Inflammation of the brain is a disease that most quickly 
depresses the human body, and of that very depression 
the patient dies. Then I ask, in the name of common sense, 



AND GUIDE TO HEALTH. 365 

shall we give aid to the destroyer by lowering the vital 
forces of the system? The antiphlogistic regimen has 
been almost the universal practice ; patient after patient 
have been subjected to it, only to die. Dr. Abercrombie, 
in speaking of the results of such a course of remedies, 
says : " The cases which thus terminate favorably form, 
it must be confessed, but a small proportion of those 
which come under the view of a physician of considerable 
practice ; but they hold out every encouragement to per- 
severe in the treatment of a class of diseases which, after 
a certain period of their progress, we are too apt to con- 
sider as hopeless." Dr. Tanner says, after making the 
above quotation from Dr. Abercrombie : " With the 
greatest respect for this excellent physician's opinions, it 
still seems to me that the extensive failure of one plan 
of treatment should merely lead us to try another ; and 
more especially, perhaps, to see if nature, unaided or only 
gently guided, will not convey the patient through a 
disease where the efforts of art are notoriously so futile. 
Be this as it may, let us determine not to thwart nature, 
as we may easily do by acting upon the fallacious notion 
that the free loss of blood is well borne ; neither let us 
credit those who assert that antimony is capable of 
effecting a cure in these cases. On the contrary, we shall 
do much more good if we will be content to prescribe 
for the urgent symptoms as they arise, to calm excite- 
ment by sedatives, to lessen increased heat of body by 
diluents and tepid sponging, to prevent accumulations in 
the intestines by purgatives and to diminish maniacal de- 
lirium by the application of cold to the head." Thus we 
have the correct plan before us, as far as he has gone ; 
but the system must, when depressed, be sustainad. 

But to particularize for general principles is not enough 
to lay down in a family practice, for it is not sup- 



066 THE FAMILY PHYSICIAN 

posed that every one will understand how to fulfill all 
these indications, nor can he afford to investigate and do 
the thinking, so we undertake to do the thinking for 
him : Commence by giving ten grains of calomel and ten 
grains of jalap, followed in four hours by some of the 
salines in ordinary doses every two hours, until an action 
is had freely on the bowels. It is often a very difficult 
matter to get any action of the bowels, and for this rea- 
son I would recommend another cathartic, more efficient 
and entirely free from danger : oil of croton four drops, 
sugar two drachms, mucilage of gum arabic one ounce. 
Of this preparation give a teaspoonful every fifteen or 
twenty minutes until an action is had on the bowels. Ice 
water should be allowed freely. The hair must be cut 
short and cold lotions or ice applied to the head ; pounded 
ice in a bladder applied to the head is an excellent thing, 
and should not be neglected. At the same time it must 
be remembered that cold will powerfully depress, 
hence there must be some discretion used in the use of 
it. If ice can not be had^ a small stream of cold water 
may be poured upon the crown of the head for several 
minutes at a time, then discontinued for a few minutes, 
and again applied, using proper caution not to depress 
the patient. 

While the cold is being applied to the head the feet 
should be, if possible, immersed in warm water ; if this 
can not well be done on account of the intractability of 
the patient, bottles or jugs containing hot water should 
be placed to his feet. 

His body, during the violent febrile excitement, should 
be sponged with tepid water. Iodide of potassium is said 
to directly modify the morbid action ; it should be given 
in three grain doses every four or six hours, dissolved in 
two tablespoonfuls of water. I now come to speak of an 



AND GUIDE TO HEALTH. 367 

article that many medical men forbid the use of in this 
disease ; I refer to opium. It is claimed, and correctly 
too, that opium exerts a particular influence on the "brain. 
The objectors to its use claim that this influence is ex- 
erted by producing a stagnation, or at least a sluggish- 
ness, in the circulation, allowing the blood to accumulate 
about the brain, and consequently oppressing that organ, 
which oppression deadens the nervous sensibility, pro- 
ducing the narcotic and sedative effect. ISTow, granting 
all that, if you please, still you have no valid objection 
to the use of the article. It is not claimed that opium 
relaxes the blood vessels and makes a greater capacity 
for blood, but, on the other hand, it rather contracts them. 
What is the condition of the blood vessels about the 
brain ? It is simply this : they are already filled to their 
utmost capacity. Thus opium can not cause any further 
accumulation, and the inactivity and bluntness of the 
nerves is just what we want. Everything about an in- 
flamed organ must be kept just as still and quiet as 
possible, so that it may be allowed to rest as it were, and 
gain strength at every opportunity. Hence it is good 
practice in inflammation of the brain, or in any other 
inflammation, to keep the patient, to a greater or less 
extent, under the influence of opium or morphine. For 
this purpose opium in one grain doses, or morphine in 
one-fourth grain doses, should be used often enough to 
make a decided impression. 

As soon as the system exhibits signs of depression 
stimulants must be given. For this purpose Norton's 
Virginia Seedling wine and beef tea, or good port wine 
and beef tea, should be freely used ; sometimes brandy 
toddy will have to be used freely. 

Great care will be necessary during convalescence. 
Patients recovering from this disease are very easy to 



368 THE FAMILY PHYSICIAN 

relapse, and a relapse would scarcely be recovered from. 
In fact the disease must be watched very closely from its 
very inception to its close, and managed very carefully. 
It is a fearful malady, and one that, under the old form 
of treatment, has proved very disastrous. 



AND GUIDE TO HEALTH. 369 



CHRONIC INFLAMMATION OF THE BRAIN. 



SYMPTOMS. 

The symptoms of chronic inflammation of the brain 
are very much like the symptoms of insanity : there is 
either great mental excitement or depression ; some 
absurd whim exists to gratify which every thing else 
must be sacrificed. Hesitation in speaking, stiffness of 
some of the muscles, headache, loss of appetite and 
constipation are among the prominent symptoms of this 
complaint. 

As the disease progresses the evidence of cerebral 
disorder is more fully developed : the memory fails, the 
external senses become impaired, paralysis often shows 
itself, and the general health completely breaks up. 

TEEATMENT. 

The duty of the practitioner is very plainly marked 
out here. " The general health completely breaks up." 
By a careful course of hygienic measures we must sup- 
port the general system. This is indispensable, and is 
not in any case to be neglected ; and while we do this 
we must combat the symptoms that present themselves. 
If there be great mental excitement or irritability, we 
must, to combat this symptom, depend upon opium or 
morphine, using cold applications to the head. If the 
depression be great we must depend upon stimulants — 
generous wine or brandy and beef tea. The bowels- 

must be kept open, but not severely purged. 
24 



370 THE FAMILY PHYSICIAN 

This disease may run its course in a few months, or 
it may last for years. It is not of frequent occurrence. 

TUBEHCULAK MENINGITIS. 

This is a disease of early life ; seldom met with after 
the child is five or six years old. 

SYMPTOMS. 

A dry cough, peevishness, intolerance of light and 
sound, headache, giddiness, and other signs of cerebral 
congestion, together with general fever, presenting 
remissions at irregular periods. The skin is hot; the 
appetite capricious — sometimes bad, sometimes vora- 
cious ; the tongue furred, and breath offensive ; there is 
often nausea and vomiting, and the bowels disordered 
— generally constipated. 

The child is drowsy yet restless ; it sleeps badly, moans 
or grinds its teeth, screams and wakes suddenly in 
alarm. 

In four or iive days, if the disease is unchecked, the 
child wishes to remain quietly in bed ; its countenance is 
expressive of anxiety and suffering; its eyes are kept 
closed, and it is annoyed by any light or noise. The 
pulse which has hitherto been rapid — say one hundred 
and twenty — falls now to eighty or ninety. The child 
now becomes stupid and heavy ; convulsions frequently 
occur, and sometimes paralysis. In a week or two the 
drowsiness passes into profound coma, from which it is 
impossible to arouse the child. The pulse gets feeble, 
the extremities cold, and a cold clammy sweat breaks 
out over the body. The child is attacked with convul- 
sions or paralysis, which soon end its sufferings in death. 



AND GUIDE TO HEALTH. 371 

TKEATMENT. 

The treatment of this disease in children has always 
been looked upon as very difficult. The disease "being 
inflammative it was thought to demand the antiphlogistic 
regimen — "bleeding, purging and antimony, which are 
measures the patient could not bear, they being strumous 
or scrofulous subjects, as they are. This difficulty is 
abolished if the observations made in the preceding 
pages are at all sound. Observation and common reason 
teach us that the less we deplete in this disease, and 
the more we act up to the spirit of the preceding pages, 
the greater will be our chances of success and the 
chances of the ultimate recovery of our patient. 

Purgatives are very useful, and are the only articles 
we will use belonging to the fatal antiphlogistic regimen. 
It will be necessary to give a full dose of calomel, 
enough to purge at least every other day, in the com- 
mencement of the disease. But our main reliance must 
be had on iodide of potassium. This must be given 
freely — say to a child three years old, from one to two 
grains every four hours, dissolved in a tablespoonful of 
sweetened water. The local application of cold water by 
means of a cloth wrung out of cold water to the child's 
head will be of much service ; this must not be neg- 
lected and it must be frequently changed. 

If the child should become depressed, which it cer- 
tainly will in the course of the disease, stimulants must 
be given it. A child, six or twelve months old, may take 
every hour or two a teaspoonful of Norton's Virginia, or 
Port wine, in as much beef tea ; and if older the dose 
should be increased. 

The child's system must be sustained, or it will pass 
from one to the other grade of symptoms above laid 
down, and death will soon close the scene. 



372 THE FAMILY PHYSICIAN 

But with the above treatment and hygienia I feel con- 
fident that snccess mil generally crown our efforts, and 
the great mortality nnder the old plan of treatment will 
be very mnch lessened. A fundamental principle in 
the practice of medicine is to sustain and not depress 
nature. Keep this in mew and you can not materially 
err. 



AND GUIDE TO HEALTH. 373 



CEREBROSPINAL MENINGITIS. 



Ail individual may have inflammation of the mem- 
brane of the brain, or may have inflammation of the 
spinal cord, or may have inflammation of both, in which 
case it is termed cerebrospinal meningitis. 

SYMPTOMS. 

Sometimes the morbid action is set np in both situa- 
tions at the same time, while in other instances the 
membranes of the brain are first attacked and the disease 
spreads downward, or vice versa. But it is remarkable 
that cerebro- spinal meningitis occurs sometimes as an 
epidemic. When this is the case it brings with it terror 
to the minds of the inhabitants, and under the depletory 
or antiphlogistic regimen it well may, for death marks 
its course ; still the same fatal remedies are prescribed 
and the same fatal course is pursued. 

The attack is commenced by acute pains, often of a 
burning character, in the back part of the head, ex- 
tending along the spine, and sometimes into the limbs. 
The pain is much aggravated by motion or pressure, 
often simulating rheumatism, rigidity of the muscles of 
the neck and back, paralysis of the lower extremities, a 
sense of suffocation, retention of urine and obstinate 
costiveness. Sometimes in the course of this disease red 
or dark spots will appear on the skin, and from this 
circumstance the name has been given by the ignorant 



374 THE FAMILY PHYSICIAN 

of " spotted fever ;" lience in some localities it is known 
and feared as spotted fever. I need scarcely say there 
is no such disease known to medical men as spotted 
fever — it is a myth. Such a disease, however, was re- 
ported to be away down in Massachusetts about the first 
of the present century ; it has not been seen or heard of 
since by any medical writer. It was no doubt some 
species of typhus or congestive fever. 

TKEATMENT. 

As has already been indicated, I will not recommend 
the popular treatment — depletion in the disease — but 
just the opposite. The treatment laid down for inflam- 
mation of the brain is, to my mind, the proper treatment 
for cerebro-spinal meningitis, only making the local ap- 
plication of cold to the back part of the head and spine 
as well as the crown of the head. In all other respects 
it should be treated precisely as inflammation of the 
brain. Care must be taken to see if the patient voids 
his urine ; if he does not, it must be drawn off regularly 
with a catheter. My confidence is so great in the sus- 
taining and palliative treatment laid down for these dis- 
eases that I recommend it most cheerfully. It has proved 
successful in my hands beyond my most sanguine expec- 
tations. It will prove successful in the hands of any 
careful practitioner who will study in the great school of 
nature and learn from her and her efforts his duty at the 
bedside of the sick. The successful physician must learn 
of her ; he must know and second her efforts ; he must 
sustain her when disease makes its assaults upon her ; 
he must help her to ward off the blow ; he must not join 
in with the enemy and help take away her strength by 
drawing from her the crimson fluid of life, for the blood 
is the life, nor must he lower her powers by the extrava- 
gant use of mereury and antimony. 



AND GUIDE TO HEALTH. 375 

A well man can not live long without food, but the sick 
man is expected to do for days and weeks almost entirely 
without it. Take the well man, if you please, bleed, 
and mercurialize him, purge him freely every day, bleed 
him until he faints daily, give him antimony freely, and 
blister him, at the same time allow him nothing to eat 
but a little thin gruel, and see how many weeks he will 
last. Can a sick man stand more than a well man? 
It would seem that physicians think so ; by their actions 
they seem to say so. 

It is a fatal mistake, and one that has caused almost 
as much premature death as disease has. I know the 
idea is thoroughly impressed on the minds of the people 
that the sick must not eat ; and I know that any other 
theory than that of starvation will be looked upon with 
a good amount of skepticism and mistrust. But this thing 
has got to be reformed, and had as well be taken hold of 
now as to wait until countless thousands more of our 
fellow men perish. The lowering plan of treatment must 
be abandoned, and will be abandoned. 

I want it to be understood that, in my theory of diet, 
it would be worse than folly to force food on a man's 
stomach when it is repulsive to that organ ; it would 
only burden it with a weight that would not be digested, 
and would prove a positive injury to the patient. But 
if the system is becoming depressed, you can give him 
good wine or brandy, beef tea, &c, and when the 
stomach demands food you can make a judicious selec- 
tion and give it to him ; but you must use proper judg- 
ment and discretion about the quantity and quality of 
the food. The point I want to be remembered is this — 
that the system must be sustained, either in sickness or 
in health, by food or stimulants and tonics ; that disease 
will lower the system and extinguish life only too fast 



376 THE FAMILY PHYSICIAN 

without any of your help. It is against this lowering of 
the vital forces that the physician must direct his best 
energies. " Curing disease " is a thing now almost un- 
thought of by the intelligent physician. Patent doctors 
and quacks only harp aloud on that string. The intelli- 
gent physician only tries to guide the system, remove 
the cause if possible, palliate the symptoms, sustain 
nature through, and leave the work of cure where it pro- 
perly belongs — to the vis natures medicatrix. Of itself it 
is sufficient to cure numerous diseases, in almost all its 
influence is beneficial, and moreover, the remedies that 
are in their own nature the best are only of use in as far 
as they stimulate, direct and control this inherent virtue. 



AND GUIDE TO HEALTH. 877 



PNEUMONIA. 



Pneumonia is an acute inflammation of the substance 



of the lungs. 



SYMPTOMS. 



It is usually ushered in by a chill or a sensation of 
coldness, followed by fever; in a short time a dull, 
obtuse pain in the breast is experienced, which is not so 
severe in its character as the pain in pleurisy, and which 
is considerably increased on coughing or making a full 
inspiration. 

The breathing is hurried and difficult, especially when 
lying on the affected side ; a dry, painful cough is pre- 
sent from the beginning, but sometimes it is moist, and 
the expectoration varies, both in color and consistence, 
being white, transparent and tenacious, semi-transparent, 
or rust colored, and frequently it is streaked with blood, 
which, however, is not an alarming symptom ; the skin, 
with heat of the body, thirst, anxiety and flushed face, 
is sometimes swollen and of a purplish hue. 

At the commencement the pulse is usually full, strong, 
hard and frequent, but as the disease progresses it be- 
comes weak, soft, and often irregular. The tongue is 
generally dry and thickly coated with a white substance. 

If the disease be connected with some derangement of 
the liver, the coat on the tongue will be of a yellowish 
or brown hue. Pneumonia is often associated with 
pleurisy, and still oftener with bronchitis, which compli- 



378 THE FAMILY PHYSICIAN 

cations may render the true character of the disease 
very obscure. This, however, practically, is not of great 
importance, as the treatment will not vary much between 
inflammation of the pleura or the bronchial tubes and 
the lungs. If the great principle laid down in this work, 
of sustaining and palliative treatment, be correct, it of 
course applies as appropriately to inflammation of one 
part of the body as to another. All inflammation, 
whether of the brain, membrane, veins, muscles or mucous 
or serous membrane, are of the same general character ; 
consequently the course of treatment, to be correct in 
principle, must be the same in character. 

And if you find the same treatment recommended for 
all cases of inflammation do not charge me with routin- 
ism, but give me credit for carrying out the great and 
correct principle that I have laid down. 

Pneumonia may be said to consist of three stages. 
The first stage, that of engorgement of the lungs ; the 
second stage may be termed that of hepatization ; and 
the third that of gray hepatization or purulent infil- 
tration. 

Pneumonia may affect one lung or both, or, techni- 
cally speaking, it may be double or single. The right 
lung suffers from inflammation nearly twice as often as 
the left ; about once in eight cases both are affected. 
The lower lobes are more obnoxious to inflammation 
than the upper. The average duration of the disease, 
when uncomplicated, is about fourteen days ; when com- 
plicated, about twenty-one days. 

TREATMENT. 

After what I have said in regard to the treatment of 
inflammation but few remarks will be necessary on the 
treatment of pneumonia. Bleeding, mercury and anti- 



AND GUIDE TO HEALTH. 379 

mony are the agents upon which we have been taught to 
rely. Whatever may have been the nature of this disease 
in years that have gone by I can not tell, but I am 
certain such treatment applied to pneumonia now would 
prove most disastrous. The first thing that should be 
done is the opening of the bowels ; this may be done by 
a dose of three or four of the compound cathartic pills 
U. S. D., or it may be done with oil or citratized magnesia. 
The patient must be kept very quiet in bed. The room must 
not to be too hot ; if in winter, the air can be kept moist 
by the evaporation of boiling water. The temperature 
should not be allowed to fall below 60 ° Fahr. Half an 
ounce of the liquor of acetate of ammonia may be given, 
with eight or ten drops of the wine of colchicum, every 
four hours. If there be pain or restlessness, some of the 
preparations of opium — say Dover's powders, ten grains 
once or twice a day, according to the urgency of the 
symptoms — may be given. If the pain in the side or 
chest be very severe, a cloth wrung out of warm water 
with a few drops of turpentine dropped upon it must be 
applied over the pain. 

All else that will be necessary will be plenty of cold 
ice water and beef tea to drink. The diet should be 
light, and after the fourth day a teaspoonful of the syrup 
of squills may be given five or six times in each twenty- 
four hours. Care should be taken when a crisis comes 
of sweating or diarrhea not to check it unnecessarily. 
Tonics, such as quinine or tincture of barks, should be 
used during convalescence. The patient may need stim- 
ulants during the last stages of the complaint ; keep the 
bowels gently open, use cold drinks, Dover's powders 
and beef tea. It will be noticed that I frequently recom- 
mend the use of beef tea. I do so because it is the very 
best article of nourishment that I know of ; but if it is 



380 THE FAMILY PHYSICIAN 

unpalatable or can not be had, other things may be nsed 
in its place. Chicken tea is a good substitute, or mutton 
tea, &c. Should the inflammation end in gangrene, stim- 
ulants and tonics will be required ; give also liquorice, 
sodse chlorinate three teaspoonsful, laudanum a half tea- 
spoonful, camphor mixture eight ounces ; mix and give 
one ounce three times a day. Brandy and nourishment 
must be given freely. A fomentation of poppy heads or 
hops may be used alternately with the turpentine stupes. 
The feet may be bathed and kept warm by hot rocks, 
bricks or bottles of hot water. The above treatment will 
look quite simple for such a fearful disease as pneumo- 
nia, particularly to those who have been used to the 
heroic plan. But it is a fact well substantiated by sta- 
tistics that under the antiphlogistic regimen more patients 
die, or a greater proportion of patients die, than there 
does of those who are treated by diet alone. This is 
true, and is a sad comment on the practice. This will 
appear from the reports of hospitals ; and if any thing 
can be gained from experience and statistics in the way 
of knowledge and to guide us in the future, we ought to 
avail ourselves of it and be governed by facts, whether 
they sustain any preconceived notions of ours or bolster 
up any cherished theory. 

It appears, from the published statistics of the Royal 
Infirmary of Edinburgh, that upward of one-third of all 
the patients affected with pneumonia who entered during 
a period of ten years died. The total number of patients 
with pneumonia entering the Royal Infirmary of Edin- 
burgh from July 1st, 1839, to October 1st, 1849, was 648. 
Of this number were cured 388 and 38 relieved — in all 426, 
while 222 (a fraction over one-third) died. 

These patients were treated by the antiphlogistic 
regimen, bleeding and antimony, with low diet. The 



AND GUIDE TO HEALTH. 381 

mortality is fearful. M. Louis records 107 cases, of 
which 32 died— about 1 in 3 1-3. It may be, I think, 
safely stated that the deaths in the hospitals treated by 
the regular antiphlogistic treatment will average one in 
from three to four. 

Dr. Dieti treated 380 cases of primary pneumonia, in 
the charity hospital of Vienna, of which 85 were treated 
by bleeding ; 68 got well and 17 died. 106 by large doses 
of tartar emetic ; 84 got well and 22 died. And 189 by 
diet only ; 175 got well and 14 died. In the cases treated 
by diet alone the mortality was only about 1 in 13 1-2. 

Dr. Bennett treated 78 cases of pneumonia, in the Royal 
Infirmary of Edinburgh, by the use of salines in small 
doses during the febrile excitement, with a view of di- 
minishing the vicosity of the blood. When the pulse 
became soft he ordered beef tea and nutrients, and if 
there was weakness, from four to eight ounces of wine 
daily. As the period of crisis approached he gave a 
diuretic, consisting of half a drachm of nitric aether, 
sometimes combined with ten drops of colchicum wine, 
three times daily, to favor the excretion of urates. The 
result of this simple practice in the 78 cases was, 75 were 
cured and 3 died — only a mortality of 1 in 26. 

Now, if statistics are worth anything at all, they es- 
tablish the supremacy of the sustaining treatment over 
the antiphlogistic, and in fact the treatment by diet alone 
is much better than the depletory system. 

It will be observed that Dr. Bennett has treated his 
cases without opiates, and without any care whatever of 
the skin — two very important things in the treatment of 
diseases attended with any febrile symptoms, exudation 
or pain. He has also neglected to use any local applica- 
tions, while it is a conceded fact that great advantage 
can be derived from the use of cold to an infL^mmation 



382 THE FAMILY PHYSICIAN 

in the first stage, and warm fomentations or poultices in 
the more advanced stages. 

With these plain, common- sense principles before you, 
it does seem to me that the successful treatment of pneu- 
monia is an easy thing. Do not try to cut the inflamma- 
tion short; you only endanger the life of the patient 
without a shadow of chance to cut short the disease. 
Content yourself with trying to pilot him through the 
turbulent stream to a safe landing, which you will suc- 
ceed in making twenty-five times out of twenty-six — a 
result that can not be reached by any antiphlogistic regi- 
men ever practiced. 

The average duration of the disease under the anti- 
phlogistic regimen is about from eighteen to twenty days, 
while the average duration under the sustaining plan or 
system is only about fourteen or fifteen days. 

Now, if the statements above given are to be relied on 
— and they certainly are, for they are given by no less 
authority than Dr. Bennett himself — it would be madness 
to continue the antiphlogistic treatment in inflammatory 
diseases at least ; and if they are worthless in that class 
of disorders, where can they be recommended? The 
question presses for an answer. 



AXD GUIDE TO HEALTH. 383 



PLEURISY. 



Fleuritis is an inflammation of a membrane in the 
chest called the pleura. 

SYMPTOMS. 

The symptoms are much like the symptoms of pneu- 
monia, the disease being sometimes taken for pneumonia. 

Pleurisy usually commences with chills, succeeded by 
heat and thirst, restlessness, and other ordinary fever 
symptoms. These are followed, sooner or later, by an 
acute pain in the side or chest, which is much aggravated 
on making a full inspiration, and is accompanied with 
hurried, difficult breathing and a dry, hacking cough. 
Sometimes the pain occurs as the very first symptom. 
Coughing, breathing and moving about increase the pain, 
as well as lying on the affected side. Persons laboring 
under an attack lie upon the unaffected side and endeavor 
as much as possible to breathe without much expansion 
of the chest, respiration being chiefly performed by the 
muscles of the abdomen, and when effusion takes place 
the patient will shift his position and lie on his back. 
The pulse is hard, strong and frequent, the tongue is 
coated, the patient is very restless, the urine scanty and 
high-colored, and the bowels torpid. The pain may be 
located at one spot, but generally it extends over a large 
extent, and sometimes implicates both sides of the chest. 
When the substance of the lungs is also inflamed there 



384 THE FAULT PHYSICIAN 

may Tbe an expectoration of mucous, which will be 
streaked with Mood if the disease has extended to the 
bronchial mucous membrane. In from forty- eight to 
sixty hours the pain lessens or ceases entirely, indicating 
that effusion has taken place ; "but in severe attacks the 
pain will continue long after effusion has occurred. 

TEEATMEXT. 

The same general rules may be observed in the treat- 
ment of pleurisy that are laid down for the treatment of 
pneumonia. One indication, however, in the treatment 
of pleurisy is, to produce if possible free perspiration. 
This can often be done by the use of tincture of Virginia 
snakeroot in teaspoonful doses every half hour in one or 
two ounces of pleurisy root tea. In connection with this 
the patient may take a large dose of Dover's powders, 
say fifteen grains ; this will to a very great extent ease 
the pain while it will most likely produce perspiration. 
Scarification and cupping to the amount of three or four 
ounces of blood from the painful side will often give 
temporary relief, so, also, will fomentations of hops, 
tansy or other bitter herbs. The bowels may be kept open 
by the use of the compound cathartic pill, U. S. D. The 
diet should consist of gruel, or boiled milk, or milk and 
water ; the drinks cold — nothing so good as ice water. 
The belladonna ointment smeared over the painful part 
is good palliative treatment. If the patient is in a 
condition that he can take a spirit vapor bath it will 
forward our views in producing perspiration. The pa- 
tient should not, under any circumstances, be subjected 
to the " antiphlogistic regimen," his system should not 
by any means be lowered; if it is, and then effusion should 
take place, his chances for life are greatly lessened, if 
indeed his case is not entirely hopeless. 



AND GUIDE TO HEALTH. 385 

If tlie above means prove insufficient and effusion takes 
place, we must then endeavor to promote absorption. A 
succession of blisters must be applied to the diseased 
side, while purgatives and diuretics are to be given. The 
citratized magnesia will answer for the purgative, and 
sweet spirits of nitre, in teaspoonful doses, in one or two 
ounces of pleurisy root tea every two, three or four hours, 
or a tea made of watermelon seed will sometimes answer. 
The iodide of potassium, in from two to four grain doses 
three times a day, must be taken. It can be taken in two 
or three teaspoonfuls of pleurisy root tea. If the iodide 
of potassium does not agree with the stomach, syrup of 
iodide of iron may be given in doses of from twenty to 
thirty drops three times a day. The use of mercury 
should not be resorted to in this stage of the disease. 
The diet must be light and nutritious. 



INFLAMMATION OF THE LIVER. 



Hepatitis. — Inflammation of the liver may be confined 
to the peritoneal covering of the liver, to its substance, 
or a part of it, or it may involve the whole of these. The 
inflammation has been divided into acute and chronic. 

In disease of the liver there is a great amount of 
ignorance displayed, both by professional men and their 
patients, who not only attribute nearly every form of 
disease to an abnormal condition of this organ, but are 
impressed with the mistaken idea that blue pill or calo- 
mel only are the true remedies for its cure. The conse- 
quence of such views have been truly lamentable, for it 
25 



386 THE FAMILY PHYSICIAN 

is rarely that a patient thus treated has escaped without 
some permanent and harassing affliction. No prepara- 
tion of mercury is required in the treatment of diseases 
of the liver. Dr. Abercrombie's observation remains 
true, that mercury is employed "with very undefined 
notions as to a certain specific influence which it is be- 
lieved to exert over all the morbid conditions of this 
organ. If the liver is supposed to be in a state of torpor, 
mercury is given to excite it ; and if it is in a state of 
acute inflammation, mercury is given to moderate the 
circulation and reduce its action." 

SYMPTOMS. 

The acute species of this complaint comes on with a 
pain in the right side, extending up to the shoulder, 
which is much increased by pressing upon the part, and 
is accompanied with a dry, short and frequent cough, 
oppression of breathing, and difficulty of lying on the 
left side, together with nausea and sickness, and often 
with a vomiting of bilious matter ; tongue coated. The 
urine is of a deep, saffron color, and small in quantity ; 
there is loss of appetite, great thirst and costiveness, 
with a strong, hard, frequent pulse. When the disease 
has continued for some days the skin and eyes become 
tinged of a deep yellow. 

The chronic species is usually accompanied with a 
morbid complexion, loss of appetite and flesh, costive- 
ness, indigestion, flatulency, pains in the stomach, a 
yellow tinge of the skin and eyes, clay colored stools, 
high colored urine, depositing a red sediment ; an obtuse 
pain in the region of the liver, extending to the shoulder, 
and not unfrequently with a degree of asthma. The 
patient often finds it almost impossible to lie on the left 
side — this is when the liver has become much swollen 



AND GUIDE TO HEALTH. 387 

and its weight causes the pain. The symptoms are, 
however, often so mild and insignificant as to pass almost 
unnoticed, as large abscesses have been found in the 
liver upon dissection which in the person's life time had 
created little or no inconvenience, and which may have 
been occasioned by some previous inflammation. Hep- 
atitis, like other inflammations, may end in resolution, 
suppuration, gangrene or scirrhus, but its termination 
in gangrene is a rare occurrence. 

TEEATMENT. 

This may be commenced in the acute by the use of the 
spirit vapor bath ; as soon as this is given the patient 
must be wrapped in a blanket and put to bed with a jug 
of hot water or with hot bricks to his feet. 

A fomentation of hops or tansy must be applied over 
the region of the liver, and a large dose of the citratized 
magnesia or castor oil, with a third or half grain of mor- 
phine, must be given. 

The nitrate of potash in ten grain doses three times a 
day should be used as a diuretic. The bowels must be 
kept in a soluble condition by the use of salts and senna 
or magnesia, and a Dover's powder, consisting of ten 
grains, should be given every night. As soon as the 
febrile symptoms begin to give way quinine, in one or 
two grain doses, must be given four or five times a day. 
Great attention must be paid to the skin ; it must be 
sponged at least once a day with tepid water, to which a 
little saleratus or soda has been added. Wine or 
brandy must be used if it become necessary to sustain, 
the system. 

The treatment for clironic inflammation of the liver 
must consist in keeping the bowels gently open and the 
use of the iodide of potassium — three grains three times 



388 THE FAMILY PHYSICIAN 

a day, dissolved in one or two teaspoonfuls of water. 
Tonics and stimulants are indicated, and must be given 
mildly. The diet must be nutritions and easy of diges- 
tion. The system should be built up and sustained. 
Traveling in agreeable and pleasant company will be 
found very beneficial. A large strengthening plaster 
may be worn to advantage over the region of the liver. 



INFLAMMATION OF THE STOMACH. 

GASTKITIS. 



This consists in an inflammation of the lining mucous 
membrane of the stomach, which may also involve the 
peritoneal coat or covering. It may be either acute or 
chronic. 

SYMPTOMS. 

A burning heat in the region of the stomach, with 
swelling, pain, nausea and vomiting ; this is aggravated 
by everything taken into the stomach, by pressure, by 
motion, and by a full inspiration. 

If simply the mucous membrane is affected there will 
not be much if any pain. In all inflammations solely of 
mucous tissue there is little, if any, pain ; it is other 
tissues becoming involved, either from sympathy or from 
extension of the inflammation to them, which causes the 
pain. 

Difficulty in swallowing will be experienced from a 
spasmodic condition of the esophagus ; great thirst is a 
constant symptom, and a very troublesome one, as all 



AND GUIDE TO HEALTH. 389 

fluids taken into the stomach, in any quantity are ejected 
"by it immediately ; restlessness, rolling of the body and 
wakefulness, hard, contracted and frequent pulse, heat 
and dryness of the skin, great anxiety, oppression and 
prostration, are present when the disease is fully de- 
veloped. 

The tongue is clean, with elevated papillae, the coun- 
tenance is shrunken and contracted, and sometimes there 
is a harassing cough, the point and edges of the tongue 
are red, and the bowels constipated. As the disease 
augments in violence the difficulty of breathing increases, 
as well as the pain caused by deep breathing ; there is 
great depression, with faintness, hiccough, an intermittent 
pulse, cold, clammy sweats, coldness of the extremities, 
tympanitis, delirium, stupor or convulsions, and death. 

CAUSES. 

Among the causes of inflammation of the stomach may 
be reckoned acrid substances taken into it, such as 
arsenic, mineral acids, oxalic acid, corrosive sublimate, 
improper food, alcoholic drinks, gout, bilious fever, 
wounds, or drinking cold water in too great a quantity 
when the body is much heated, or over fatigue by exer- 
cise. 

TEEATMENT. 

If the inflammation is caused by any improper sub- 
stance taken into the stomach the first thing to be done 
is to have it ejected by a prompt emetic, or remove it by 
means of the stomach pump. If an emetic is determined 
upon, a tablespoonful of ground mustard in half a pint 
of warm water will act as promptly as anything that can 
be given, or twenty -five grains of ipecac in half a pint of 
warm water is sure to act. As soon as this is done, give 
the proper antidotes for the poison, which will be found 



390 THE FAMILY PHYSICIAN 

detailed under the head of "Poisons and their Antidotes." 

After the ejection of the poison the inflammation may 
continue ; if so, the body should "be well sponged with 
tepid water, or if the patient is able, a spirit vapor bath 
should be given, after which the patient may have mus- 
tard applied to the stomach, feet, ankles and spine, or 
fomentations of hops, tansy, &c, applied to the same 
localities. A full dose of morphine should be adminis- 
tered and continued at proper intervals to quiet the 
patient. For the thirst he may take small quantities of 
cold, mucilaginous drinks, or, what is better, hold ice in 
his mouth and occasionally swallow lumps of it. 

The bowels must be moved once a day by injection of 
castor oil, molasses and warm water, after which brandy 
toddy and strong beef tea should be injected well up 
into the rectum three or four times a day. Recollect that 
depression is a prominent symptom and must be pro- 
perly attended to, or combated by sustaining the system. 
This can not be done in the ordinary way, and therefore 
must be done by injection. 

This disease is a dangerous . one, often terminating 
fatally in a few hours. 

The stomach must be disturbed as little as possible, 
and emetics should never be given except to remove some 
acrid or poisonous substance. Cold applications to the 
stomach have sometimes been very beneficial in allaying 
the inflammatory symptoms. The patient's feelings 
should be consulted in this matter ; in fact it is always 
safe to consult the patient's feelings in the use of cold 
or warm applications — nature always seems to appre- 
ciate that which is best for her ills. This is a rule that 
should guide us in almost every thing, even in the most 
critical cases. It is always safe to listen to the voice of 
nature ; her discriminations are always good and her 



A^D GUIDE TO HEALTH. 391 

judgment is unerring. The physician who studies in her 
school and listens attentively to her counsels is the most 
successful. 



Chrunic Inflammation of the Stomach. 



The term "dyspepsia" is almost always applied to 
this disease. This is not proper ; the diseases are distinct 
and should be treated as such — it must not be confounded 



with "indigestion." 



SYMPTOMS. 



Pain in the region of the stomach is one of the first 
symptoms, especially soon after eating ; the appetite 
becomes irregular and fastidious ; the food is poorly 
digested : in consequence accumulation of gas takes 
place. The appetite will sometimes be very craving, but 
on eating a mouthful or two the patient is satisfied or 
becomes nauseated. At other times the appetite will 
be entirely lost, with an unpleasant taste in the 
mouth. The thirst is as variable as the appetite. The 
dull, lancinating pain may extend from the stomach to 
the back and edges of the ribs, or there may be a sense 
of tormenting heat in the stomach. The tongue is cov- 
ered with a whitish fur, and is almost always of a vivid 
red at its tip and edges, or the whole surface of the 
tongue may be smooth, glossy and red. With the 
increased redness of the tongue the pulse will be found 
small, tense and threadlike. Coldness of the extremi- 
ties is a common symptom ; emaciation often, if the dis- 
ease is not removed, takes place more or less rapidly ; 



392 THE FAMILY PHYSICIAN 

the patient "becomes hypochondriacal, and may linger 
ont a term of years in constant misery. 

CAUSES. 

This disease is frequently a sequela of the acute form, 
but it more often supervenes an attack of small-pox, 
scarlet fever, typhus, &c. Intemperance in eating and 
drinking is the most frequent cause of chronic gastritis. 

TEEATMENT. 

The first thing to be done is to regulate the patient's 
diet, and if he is intemperate, to see that he abstains 
from alcoholic drinks. His diet had better be rice, 
barley water, or chicken tea, or some other of the nutri- 
tious and easily digested articles. His drink may be 
slippery elm water well iced, and taken in small quanti- 
ties, but often. When the symptoms have begun to 
subside a more nourishing diet should be given ; but if 
solid food is allowed, it must be most thoroughly masti- 
cated. The meals should be small and often. His body 
should be bathed by means of a sponge bath once or 
twice a day ; tepid alkaline water should be used. 

Constipation of the bowels must be overcome by the 
use of injections. The stomach had better not be cum- 
bered with any medicine. The patient should take 
exercise in the open air if he is able ; good, cheerful 
company should always be sought, and a cheerful 
disposition maintained if possible. 

In addition to proper nourishing articles of diet, 
such as beef tea, rice, boiled fresh milk, &c, it may be 
necessary to administer brandy toddy by injection. 
This will become particularly necessary if the patient 
has been in the habit of indulging too freely in drink. 

Persons afflicted with this disease are too apt to burthen 



AND GUIDE TO HEALTH. 393 

their stomachs with various drugs, all of which prove to 
be a positive injury to them. These patent nostrums in 
the shape of " bitters" must be avoided if the patient 
would ever recover from his malady. Care to general 
health, with a strict dietary system, will almost always 
speedily cure. 



INFLAMMATION OF THE SPLEEN. 

ACUTE. 



It comes on with a remarkable shivering, succeeded by 
great heat and intense thirst, pain in the left side about 
the lower ribs, and a tumor or swelling that can be 
plainly felt under and just below the lower rib, extend- 
ing sometimes downward and forward almost to the pit 
of the stomach. 

The paroxysm for the most part assumes a quartan 
form. When the patients expose themselves for a little 
time to the free air their extremities immediately grow 
very cold. If a hemorrhage happens, the blood flows 
out of the left nostril. The other symptoms are much 
the same as those of inflammation of the liver. 

Like the liver, the spleen is also subject to a chronic 
inflammation, which often happens after agues, and 
is called " ague cake" Heat, fever, tension, tumor and 
pain in the left side, increased by pressure, are its char- 
acteristics. 

TBEATMENT. 

Much the same as inflammation of the liver. 

In the chronic form of inflammation of the spleen, as 



394 THE FAMILY PHYSICIAN 

in other chronic affections, no rapid cnre can "be made. 
The preparations of iron are nsefnl in this complaint. I 
usually give it in the form of the tincture, twelve or fif- 
teen drops three times a day in half a tumbler of water. 
In cases where the enlargement is considerable iodine 
may be nsed to advantage; a good form is the sugar 
coated pill of iodide of iron. 

Particular attention must be paid to the skin and 
general system. A sponge bath in tepid water to which 
soda has been added must be had daily, and the diet 
generous, with a little malt liquor or wine. 



INFLAMMATION OF THE KIDNEYS 

NEPHRITIS. 



The inflammation may be located in the kidneys or in 
the lining membrane, but usually both are implicated. 
Often the bladder, testicles, and other parts of the urin- 
ary organs are affected through sympathy. 

SYMPTOMS. 

These are much the same as the febrile and chilly 
symptoms of other inflammatory attacks. The promi- 
nent symptom is a deep-seated pain about the loins, in 
the region of the kidneys, which pain is aggravated by 
firm pressure, by jolts and by moving about. The pain 
frequently shoots down to the groin, with a numbness of 
the thigh and a drawing up of the testicles. The pain 
is diminished by bending the body forward. There is a 



AND GUIDE TO HEALTH. 395 

frequent desire to pass urine and the effort is attended 
with much pain and difficulty. The skin is hot and dry, 
the tongue furred and yellow, the pulse hard and quick, 
there is more or less vomiting of bilious matter, while 
the bowels are constipated, and the patient lies best on 
the affected side when only one side is affected. When 
both kidneys are affected there may be suppression of 
urine, with stupor, terminating rapidly in death by poi- 
soning from urea. 

Acute nephritis runs its course rapidly and may termi- 
nate in resolution, suppuration, occasionally in indura- 
tion, but rarely in mortification. 

CAUSES. 

It may be induced by mechanical injuries, cold, strains 
of the back, intemperance, the internal use of turpentine, 
cantharides or gravelly concretions, &c. 

TBEATMENT. 

The disease runs its course so rapidly it is necessary 
for the treatment to be prompt ; it may be commenced 
by the use of the spirit vapor bath, and when the patient 
is placed in bed with the jugs of hot water to his feet, 
a warm fomentation of bitter herbs may be placed over 
the region of the kidneys and ten to fifteen grains of 
Dover's powders given. This course will quiet his sys- 
tem, ease his pain and cause him to sweat profusely. In 
the course of ten or twelve hours he should be well 
sponged with warm alkaline water and given the balsam 
of copabia in slippery elm bark tea ; he should also take 
a full dose of senna and salts. If signs of depression 
occur stimulants and tonics must be freely used, such as 
brandy toddy and quinine, with a nutritious diet. Iced 
slippery elm water should be used continually for a drink. 
In all cases of inflammation tea and coffee must be pro- 
hibited. 



396 THE FAMILY PHYSICIAN 



Chronic Inflammation of the Kidneys, 



This is frequently the result of an acute attack, though 
it may occur from other causes, such as mechanical injury? 
a peculiar character of the urine, or from a long course of 
intemperance. 

SYMPTOMS. 

"Weakness in the small of the back, heavy, obtuse 
pain in the region of the kidneys. The urine is evacu- 
ated irregularly in smaU quantities and at oft repeated 
intervals, and yields a deposit on standing. The urine 
is most commonly alkaline. It is occasionally turbid or 
white and milky in appearance. The bladder sometimes 
becomes irritable and painful. Dropsical swellings and 
weakness of the lower limbs are often met with in the 
advanced stages. The pulse in bad cases becomes fre- 
quent and smaU, hectic fever ensues, with emaciation, 
night sweats, great debility, and finaUy death. 

TBEATMENT. 

The first thing to be attended to in this complaint is 
the skin, diet, and general habits of the patient. The 
tepid alkaline sponge bath (by which is meant warm 
water to which soda has been added) once a day, and, if 
the patient is able to stand it, the spirit vapor bath or the 
Turkish bath once a week. The diet should be carefully 
selected, and consist of such articles as are nutritious and 
easy of digestion. Tea, coffee and alcohoKc drinks must 
be avoided. 



A^D GUIDE TO HEALTH. 397 

Iodide of potassium in two grain doses, in half a wine- 
glassful of slippery elm bark tea, should be taken twice 
a day, and the following diuretic taken twice a day in 
teaspoonful doses, in elm bark tea also : Sweet spirits of 
nitre, one ounce ; copaiba and canada balsam, of each 
half an ounce ; oil of juniper, oil of cubebs, and oil of 
anise, each two drachms : mix. — King 's Am. Practice. 

The bowels must be kept regular, which had better be 
done by means of injections. Moderate exercise in the 
open air must be enjoined. Radishes and watermelons, 
when they can be had, will be found of great value to any 
person laboring under this complaint. 



INFLAMMATION OF THE BLADDER. 

CYSTITIS. 



The inflammation may attack the mucous membrane 
of the bladder or its muscular coat. It may, like inflam- 
mations of other organs, be either acute or chronic. 

SYMPTOMS. 

A severe burning or throbbing pain, with tenderness, 
in the region of the bladder, increased by pressure upon 
it, is the first symptom of this complaint. The desire to 
urinate is constant, and is accompanied with great diffi- 
culty and pain ; it may pass away drop by drop, or it 
may be entirely suppressed, causing a swelling of the 
bladder and great distress. The pain may extend to the 
urethra. The urine commonly contains more or less 
mucous. There is generally fever, dry, hot skin, thirst, 



398 THE FAMILY PHYSICIAN 

and constipation of the bowels, with frequent ineffectual 
attempts to evacuate them. Sometimes nausea, vomiting, 
restlessness, and great anxiety is present. 

In unfavorable cases, as the disease advances, a low 
typhoid condition ensues, there is low delirium or 
stupidity, pale, hollow and death-like countenance, and 
the patient dies in coma or convulsions. 

CAUSES. 

Exposure to cold, active diuretics, as turpentine or can- 
tharides, injuries, the careless introduction of bougies or 
catheters, translation of gonorrhea, or injections of an 
irritating substance into the bladder. 

TREATMENT. 

This must be very nearly the same as has been advised 
for the acute inflammation of the kidneys. The bowels 
should be evacuated by the use of salts and senna or the 
citratized magnesia. The skin should be treated to the 
vapor bath and frequent alkaline sponge baths. Dover's 
powders must be taken in ten grain doses. Fomenta- 
tions of hops and tansy should be applied/ over the 
bladder; cooling and mucilaginous drinks should be 
used freely. If the bladder becomes much distended 
and the urine can not be voided, it must be drawn off by 
the use of a catheter, which must be introduced slowly 
and with very little force. 

If depression and typhoid symptoms set in, tonics 
and stimulants must be used freely, with a diet of beef 
tea and other nutritious articles. Opium enough may 
be used to procure rest. 



AND GUIDE TO HEALTH. 399 



Chronic Inflammation of the Bladder 

CHROOTC CYSTITIS. 



This is a chronic inflammation of the mucous mem- 
brane of the bladder. It is generally associated with 
some disease of the prostrate gland. 

SYMPTOMS. 

A dull, uneasy sensation of pain is felt in the region 
of the bladder, with a frequent desire to urinate and 
difncTilty in retaining the fluid in the bladder. The urine 
is mixed with mucous, which, on standing in a vessel, 
settles to the bottom, leaving the urine clear. Several 
pints of this tenacious mucous have been voided by 
some patients in a single day. Generally, when the calls 
to urinate are frequent, its discharge will be accompanied 
by spasmodic contractions of the bladder, and a painful, 
burning sensation along the urethra. There is a persis- 
tent feeling of uneasiness in the region of the bladder, a 
degree of heaviness in the perenium, pain and weakness 
in the back and loins, sometimes extending to the 
testicles. 

CAUSES. 

Chronic cystitis may follow the acute form, or it may 
be brought on by a course of intemperance, highly sea- 
soned food or excessive venery. 



400 THE FAMILY PHYSICIAN 

TKEATMEOT. 

After giving proper care to trie skin and the diet of the 
patient we should give proper diuretics. The diuretic 
drops referred to for the treatment of chronic inflamma- 
tion of the kidneys is, perhaps, the best preparation that 
can be used for this, by adding a little laudanum. 

Recipe : spirits of nitre, one ounce (fluid) ; copaiba, 
half an ounce ; Canada balsam, half an ounce ; oil of 
juniper, two drachms ; oil of cubebs, two drachms ; oil 
of anise, two drachms ; laudanum, four drachms — mix. 
Take one teaspoonful three times a day in slippery 
elm tea. In addition to this the patient should be kept 
from the use of spirits, tea and coffee. His bowels 
should be kept open by means of injections, and all 
the general rules of health strictly observed. Exercise 
in the open air should be enjoined. 

It has been recommended to inject into the bladder 
certain astringent articles, but I think the practice is not 
a safe one. Cold, mucilaginous drinks may be used 
freely, such as iced slippery elm tea or watermelon seed 
tea. "Watermelons, in their season, may be used freely. 

If any symptoms of weakness appear, stimulants and 
tonics must be had resort to, with good diet, &c. 



AND GUIDE TO HEALTH. 401 



BROICHITIS. 



Bronchitis is an inflammation of the mncons membrane 
of the bronchial tubes or air passages into the lungs. It 
is a common disease of children and by no means un- 
common among adults. It may be acute or chronic. 

SYMPTOMS. 

The first symptoms of acute bronchitis resemble those 
of cold. A chilly sensation is first felt, succeeded by 
fever, cough, rapid pulse, with pain in the upper part of 
the breast. At first the cough is hard, dry and painful, 
but soon expectoration of a clear, tenacious mucous 
takes place, which gradually becomes purulent. This 
expectoration is often profuse, and in infants is attended 
with a wheezing, rattling sound, rendering breathing 
very difficult, particularly in a recumbent position. 
When the obstruction to respiration is considerable the 
countenance becomes bluish on account of imperfect 
oxygenation of the blood— not enough air penetrating 
the lungs, where, of course, the process of oxygena- 
tion takes place — a process necessary to life. At other 
times the face is flushed, with an expression of distress 
or anxiety. There is apt to be pain in the head, particu- 
larly the forehead, which is much aggravated on cough- 
ing. "When expectoration commences freely the cough 
generally abates, and in a week or ten days convales- 
cence ensues. The tongue is in bad cases loaded, the 
26 



402 THE FAMILY PHYSICIAN 

urine is scanty and bowels costive, the "breathing rapid 
and made somewhat difficult by the accumulation of the 
mucous. 

Acute "bronchitis is very common as a secondary affec- 
tion in small-pox, measles, whooping-cough, scarlet fever, 
etc. It is sometimes complicated with pneumonia. Bron- 
chitis often arouses a latent tubercular disposition into 
activity, and consumption frequently dates from its oc- 
currence. Pain in the upper part of the chest, with a 
frequent dry, hacking cough and a small, clear, mucous 
expectoration are the prominent symptoms of bronchitis. 

CAUSES. 

It may be a complication or sequela of some other dis- 
ease, as above mentioned, or it may be caused from cold, 
change of temperature, etc. 

TEEATMENT. 

This may be commenced with the foot bath. The feet 
may be bathed for fifteen or twenty minutes in a salt 
water bath, as hot as it can be borne, then the patient 
should be placed in bed and a hot brick or two, or jugs 
of hot water, placed to them; a flannel cloth may 
then be wrung out of hot water and a dozen drops of 
spirits of turpentine be dropped on it and applied to the 
upper part of the breast, over the pain. This treatment 
in mild cases, with a dose of Epsom salts, will usually 
be enough to give relief. But if the case be a severe one, 
and the pain and distress in the chest be severe, it will be 
necessary to treat it by inhalations also. This may 
be done by placing a pint of warm water in a large bowl, 
or other vessel, and add to it half a teaspoonful of 
tincture of iodine, and then place in the vessel a hot rock 
or piece of iron — small, of course — only large enough to 



AND GUIDE TO HEALTH. 403 

make a moderate steam, which the patient can inhale by 
placing his face over the vessel. This should "be con- 
tinned for a few minntes at a time and repeated two or 
three times a day. When this is done a full dose of 
Dover's powders — say ten grains — to which two grains of 
powdered ipecac has been added, must be taken. 

The foot bath should be frequently repeated and the 
cloth on the chest frequently renewed. The Dover's 
powder should be repeated in six hours. 

At the commencement of the case, if severe, a 
cathartic of salts and senna should be given, and 
allowed to operate before the Dover's powder is 
given. Afterward the bowels may be moved by the 
usual cathartic injection of castor oil, molasses and warm 
water. If perspiration can not be produced by the 
means above recommended, the spirit vapor bath may 
be resorted to. 

The patient should be carefully watched, and, if 
depression seems to set in, stimulants and a nourishing 
diet must be given. 

CHRONIC BRONCHITIS. 

There is not often to be found any fever in chronic 
bronchitis; the cough is generally the prominent and, 
troublesome symptom. This, however, in mild cases, m 
fine weather, may be very slight, and in fact disappear 
entirely ; but on the return of cold or changeable weather 
it becomes troublesome. It is worse at night and in the- 
morning, particularly if the feet— damp with perspira- 
tion—are placed in contact with a cold floor or cold sheets,., 
etc. Upon the expectoration of mucous the fits of cough- 
ing become somewhat relieved. Sometimes slight, tran- 
sient pains are experienced in the chest, and frequently 
after a severe paroxysm of coughing a general acLihg 



404 THE FAMILY PHYSICIAN 

pain will "be felt for some mirmtes in the chest. The 
mucous expectoration becomes thick and is sometimes 
streaked a little with Mood. The tongue will be found 
coated in the morning and the appetite will generally be 
poor. As the disease advances the pulse becomes quick, 
weak and small, the breathing short, more hurried and 
oppressed, with emaciation and night sweats ; face pale, 
eyes hollow or sunken, great debility, diarrhea, sore nose, 
and the lips purple. The expectoration becomes more 
copious and more purulent and fetid. This distressing 
form may continue from one to several months, if not re- 
moved, and then prove fatal. It presents many of the 
characteristics of tubercular consumption, from which dis- 
ease it is difficult to tell it — only by auscultation and 
percussion. This is the consumption that is sometimes 
cured in the advanced stages. These are the cases that 
lull the people into the belief that some pert son of 
Msculwpius has delved into science so deep that he has 
found the great healing balm that will not only stay the 
hand of decay upon that delicate mass, the lung, but will 
replace the part that has been consumed and sloughed 
away. When man becomes able to create then this 
may be done, not sooner. 

CAUSES. 

Chronic bronchitis may occur as a sequence of the 
acute, or it may result from the diseases mentioned as 
causes in the acute form, or it may occur from the con- 
stant exposure to irritating powders, such as stone-cutters, 
millers, workers in metals, &c. 

TEEATMEISTT. 

This may be commenced by the use of the " sponge 
alkaline bath " once a day, with the application of some 
irritating application to the upper part of the breast over 



AND GUIDE TO HEALTH. 405 

the seat of pain. For this purpose a liniment— croton 
oil one drachm, and sweet oil one ounce — may be rubbed 
over a section of the breast, about two or three inches 
square, once or twice a day. The object of this is not 
to blister or produce a sore, but simply to produce an 
irritation or redness of the skin. If the liniment is not 
sufficiently strong to do this, more croton oil must be 
added ; if too strong, which is the more likely, more 
sweet oil must be added. Now, this irritation wants to 
be carried just as near to blistering as possible without 
blistering. The patient should take internally every 
morning live grains of iodide of potassium in at least two 
ounces of sweetened water, after which he should take a 
moderate draught of cold water. At noon he should 
take from three to live copaiba and cubeb capsules, which 
may be procured at any drug store, and at night he may 
take a full dose of Dover's powders (ten grains). His 
bowels must be kept regular by the use of injections, 
his exercise must be moderate but regular, and his diet 
should be most carefully selected. You see him on the 
road, the great highway of debility ; you see his system 
getting lower and lower day by day. This highway is 
the direct " air line" to death; "no change of cars," 
" no delays," but " directly through." He must be 
switched off or he will soon land at the great depot, the 
port of all our destination. But, to drop the figure, un- 
less you sustain the patient by a judicious plan of nutri- 
ment he will sink. We have already seen that his ap- 
petite is poor, and we know if he is not well sustained 
by food he will rapidly sink into the grave. Beef tea 
here must play an important part ; fresh, raw eggs must 
be well beat and suited to the taste of the patient by 
adding water, sugar and a little Jamaica rum or sherry 
wine ; milk, rice and other articles that are light and nu- 



406 THE FAMILY PHYSICIAN 

tritious must be given, and solid food, beef, mutton or 
poultry may "be used ; small quantities but often will be 
the best plan. Good rye whisky toddies may be used 
with all other means to nourish the patient. 



DYSPEPSIA. 



We now come to the consideration of a disease of the 
stomach. This organ is one of great importance ; upon 
its healthy action depends much ; in fact, upon its 
healthy action depends the health of the general system. 
It has already been urged upon the attention of the 
reader the grand importance of feeding and sustaining 
the system. 

In a former article diseases have been divided into two 
great classes — nutrition and innervation. Nutrition 
depends upon the normal action of the stomach ; hence 
the subject is one of the most vital importance. Yes, in- 
deed, upon the healthy action of this much-abused organ 
depends the all-important subject of nutrition. 

By dyspepsia (from a Greek word meaning difficulty of 
digestion) is generally understood all those functional 
derangements of the stomach which are primary in their 
origin — that is, not dependent upon, or symptomatic of, 
inflammation or other disease in the economy. Such a 
disordered condition is exceedingly common, and often 
causes the despair of the physician, arising, as it 
frequently does, from causes which are obscure or, if 
discovered, beyond his control. This will become appa- 
rent by considering, in the first place, those circumstances 



AND GUIDE TO HEALTH. 407 

wliicli require to be united to secure a healthy digestion. 
These are — 1st, A proper quantity and quality of the 
ingesta. 2d, Sufficient mastication and insalivation. 3d, 
Active contractility in the muscular coat of the stomach. 
4th, Proper quantity and quality of gastric, biliary, 
pancreatic fluids. 5th, A consecutive and harmonious 
action of the intestinal canal. Dyspepsia or indigestion 
may be produced by any cause which occasions derange- 
ment of one or more of these conditions ; and hence it is 
why so many different circumstances may produce some- 
what similar symptoms, and why so many different 
remedies have been found effectual in various cases. 
Notwithstanding that you will frequently meet with in- 
stances which baffle all preconceived rules, there can be 
no doubt that a careful attention to the essential physio- 
logical conditions above enumerated will, in the great 
majority of cases, conduct you to a successful rational 
treatment. 



Of all the causes of dyspepsia excesses in eating and 
drinking are the most common. An over-distended 
stomach, or too rich a meal, not unfrequently induces a 
feeling of weight or fullness in the epigastrium, nausea, 
and eructations of acid, bilious, or gaseous matters, with 
a loaded tongue, headache, and other general symptoms. 
This is acute dyspepsia. Occasionally there is more or 
less vomiting of bilious matter, when the attack is vul- 
garly called a " bilious attack." 

If called to treat such a case, immediately on its oc- 
currence and before the ingesta has left the stomach, as 
determined by the sense of load at the epigastrium and 
by percussion, an emetic should be given, and if vomiting 
be present it should be assisted by warm drinks. As 



408 THE FAMILY PHYSICIAN 

soon as the stomach is quieted, or, if you have been 
called in at a late period, when the ingesta have passed 
into the intestines, a purgative should he administered 
—five grains of calomel and five of colocynth— followed 
in a few hours by a draught of salts and senna or a Seid- 
litz powder. If necessary, also, an injection may be 
given. The purging, with a day or two's confinement to 
a food consisting mostly of bread, or what is termed a 
farinaceous diet, will generally get rid of such an attack ; 
but their frequent repetition leads to the chronic form of 
dyspepsia, in which careful regulation of the diet, with 
exercise, must constitute the chief treatment. Hence the 
advantage of what is termed "change of air," and much 
of the benefit which is derived from watering places. 
Chronic dyspepsia, however, is far more commonly caused 
by the excess of spirituous and vinous drinks than by 
eating, and in such cases abandonment of the evil habit 
is a sine qua non in the treatment. 

Tea and coffee drinkers are very liable to the disease, 
and its frequency among females is probably owing to 
over indulgence in these beverages. 

Tobacco chewers and smokers are also very obnoxious 
to it. Dr. Bennett observes, "It may frequently be 
noticed that those who have acquired the habit of eating 
rapidly are more or less dyspeptic. I know a journey- 
man printer, who had been much tormented with indi- 
gestion, but who was cured by changing his residence. 
The reason of this cure was for sometime a mystery. 
On again changing his house the disease returned ; still 
no apparent cause could be discovered. I ascertained at 
length that it depended not on the locality per $e, but on 
its distance from the printing house. When far off he 
ate his dinner with his family rapidly, having only just 
time enough to walk home and back within the hour. 



AND GUIDE TO HEALTH. 409 

When he lived near, the time otherwise spent in walking 
was occupied in eating, or in cheerful converse with his 
wife and family. Since I made this observation it has 
often occurred to me that the distance of the residences 
of artisans from their places of employment may he the 
occasional cause of the dyspeptic symptoms they fre- 
quently suffer from." 

The exact object of the saliva in the process of diges- 
tion, whether it be to convert the farinaceous compounds 
of the food into glucose, or by its vacidity to mix up air 
with the portions swallowed, is not positively deter- 
mined ; but its necessity for digestion is shown by what 
happens in cases where the under lip has been lost by 
accident or disease, or where salivary fistulse have 
formed : in such cases dyspepsia is generall present, and 
in some the disordered digestion has been cured by 
operations that, by restoring the parts to their normal 
condition, prevent the escape of saliva. Again, persons 
habituated to the dirty habit of spitting are for the most 
part dyspeptic. In all cases when dyspepsia can be 
traced to this source the treatment becomes obvious. 

The contractile movements of the stomach which, by 
kneading the ingesta (food) and keeping them in con- 
stant motion, secure their intimate admixture with the 
gastric juice, and the rapid transference to the duodenum 
of such portions of it as are transformed into chyme are 
evidently of great importance in the proper performance 
of digestion. The experiments of physiologists have 
shown that digestion goes on in gastric juice taken out 
of the stomach much slower than in the stomach, and 
that section of the pneumogastric nerves, by arresting 
the contractile movement, permits only the circumference 
of the mass to contract with the secreting surface to be 
digested. These facts at once explain the well known 



410 THE FAMILY PHYSICIAN 

influence of mental emotions npon the stomach. Con- 
tentment and hope are as favorable as dissatisfaction 
and despondency are injurious to good digestion. 
Nothing is more common than dyspepsia among literary 
men who overtask their mental faculties, among young 
persons of very excitable minds, and among individuals 
of a melancholy temperament, hypocondriacs, &c. It is 
in such cases that cheerful society, active and appro- 
priate occupations, change of scene, removal from mer- 
cantile or literary employments, variety in trains of 
thought, and so on, are beneficial. Our knowledge with 
regard to the offices performed by the gastric, biliary 
and pancreatic juices in digestion has, of late years, 
been much advanced. Thus, the gastric juice operates 
more especially on the albuminous, and the pancreatic 
juices on the fatty compounds of the food. 

The function of the bile is more obscure ; it probably 
acts as a means of precipitating or separating some of 
the excretory matters from chyme and so facilitates 
assimilation of the nutritive portions. Digestion may 
be deranged by all those causes which increase or dimin- 
ish too much the secretion of these three fluids. Thus 
excess of acidity in the stomach is one of the most com- 
mon causes of dyspepsia and is associated with that 
form of it which accompanies scrofulous and tubercular 
diseases. It may be in such excess as to neutralize the 
alkaline section of the pancreatic juice and render it in- 
capable of emulsionizing fatty matters. In such cases 
the alkalies with bitter tonics and the direct introduction 
of animal oils in excess are indicated. On the other 
hand, the gastric juice may be diminished in quantity, 
as frequently occurs in persons who suddenly overtask 
the powers of the stomach at feasts or in old persons 
with feeble digestion. The sense of load after eating is 



AND GUIDE TO HEALTH. 411 

generally indicative of slow digestion from this canse. In 
scute cases a stimulant rouses the stomach to increased 
action, and hence the moderate use of drains and gener- 
ous wines after dinner is occasionally useful. In old 
persons the sense of load and feebleness is best removed 
by giving up tea and drinking at night a little brandy and 
water. In chronic cases acids are indicated, especially 
muriatic acid. The tincture of iron is useful in the cases 
of chlorotic females. The prepared gastric juice of calf 
has been lately recommended as a remedy in these cases, 
and is in some cases of much service. We have no dis- 
tinct means, as far as I am aware, of rousing the pancreas 
into action, and yet many cases are on record in which 
fatty matters have passed undigested through the alimen- 
tary canal in consequence of obstruction to the pancre- 
atic duct, In such cases, and in all those in which fatty 
matters are difficult to digest, alkalies, especially the 
bicarbonate of soda, with vegetable tonics, are indicated. 
When the bile is deficient constipation and dyspepsia 
are usual results, and are to be relieved by gentle mer- 
curial purgatives. For this purpose use five grains of 
blue mass and ten grains of rhubarb at night, and if it 
should not operate by morning use castor oil. Excess of 
bile, on the other hand, ought to be treated with more 
active cathartics. The U. S. Dispensatory comp. cath. 
pill, in doses of three or four at night, will answer this 
indication. The spirits of nitre or some other diuretic 
must also be used. Exercise and the spirit vapor bath 
must not be neglected. 

A derangement of the consecutive and harmonious 
action of the alimentary canal is another frequent cause 
of dyspepsia, for it is as necessary that those portions of 
the food which are not assimilable should be removed 
out of the economy as that the nutritive materials should 



412 THE FAMILY PHYSICIAN 

be absorbed. Hence whatever impedes the contractility 
of the intestinal canal, whatever alters the structure of 
its mucous membrane, or whatever mechanically ob- 
structs its calibre, induces dyspeptic symptoms. 

The removal of these various conditions, whether by 
stimulating the nervous centres, by appropriate diet, or 
by purgatives and astringents, need not be more par- 
ticularly dwelt upon here. I would only observe that 
the constant use of laxatives, however they may tempo- 
rarily relieve, can not cure, and that in all chronic cases 
proper action of the bowels must be obtained as much as 
possible by means of dietetic and hygienic regulations. 
In many cases of dyspepsia two or more of these classes 
of causes may be combined so as to render the indica- 
tions for treatment complex and apparently contradic- 
tory. In other cases one or more causes may exist, al- 
though from the indications present their nature can not 
be determined; in such cases our treatment must be 
always more or less vague and unsatisfactory. 

Lastly, there are a few instances where dyspepsia can 
only be explained by idiosyncrasy, in which we find this 
or that particular article of diet to derange the digestive 
functions, and in which avoidance of the offending cause 
is the only plan of treatment that is attended with 
success. 

In addition to the different kinds of dyspepsia to which 
your attention has been directed, it is practically im- 
portant to keep in remembrance the leading symptoms 
which may be present. The symptoms are, anorexia 
(loss of appetite), acid eructations, sense of load at the 
stomach, vomiting, flatulence, palpitation of the heart, 
and cephalalgia (headache). 

I have already alluded to the mode of treating most of 
these symptoms. Palpitation of the heart often occasions 



AND GUIDE TO HEALTH- 413 

alarm in young dyspeptic persons, and in sncli cases, 
besides remedies directed toward the stomach, change of 
scene, removing the attention from the affected organ, 
and varied reading, should be enjoined. The sense of 
load in the stomach is most frequently removed, as I 
have previously said, by acids ; and sonr eruditions and 
cardialgia (pain of the stomach, heart-burn) are best re- 
lieved by alkalies and bitter tonics. Vomiting and flatu- 
lence are often very troublesome symptoms. To check 
these sometimes the liq. potass, muriatic tine, iron, or 
morphine may be used. A scruple (20 grains) of sul- 
phate of soda will often prove of great benefit taken 
three times a day. 

From all that has been said on the subject, the reader 
can not fail to see the importance of diet in this com- 
plaint. The patient must study this well, and only eat 
such things as agree best with his stomach. The food 
must be changed often, small quantities must be taken 
at a time, articles the most pure and easiest of digestion 
must be selected, much time must be taken in mastica- 
tion, and a cheerful disposition must be maintained. 

The skin must not be neglected. The alkaline sponge 
bath must be often used, moderate exercise must be 
taken, tea, coffee, tobacco and alcoholic drinks must be 
dispensed with, or the latter only used as a medicine in 
such cases as above recommended. Cheerful, lively 
company should be sought, and above all refrain from 
taking too much medicine, or in fact anything at all un- 
less it is absolutely indicated by some urgent symptom. 
Depend principally on nature's efforts and diet for a cure, 
and if proper care is taken you will not be disappointed. 
The common practice of most dyspeptics of taking large 
quantities of medicine daily is improper and injurious ; 



414 THE FAMILY PHYSICIAN 

it only serves to torture their abused stomachs and still 
more debilitates them, and will finally render a cure im- 
possible. 



DROPSY. 

DROPSY OF THE BR A^— HYDROCEPHALUS. 



This is in reality not a primary disease, but merely a 
result or sequel of an other disease (inflammation of the 
brain). Dropsy of the brain consists of an effusion of a 
watery fluid into the cavity of the brain. 

It is a disease peculiar to children, and one that is 
generally attended with much danger ; it is seldom found 
to occur after the fifth or sixth year. 

SYMPTOMS. 

It may be necessary here to describe the inflammatory 
stage, as well as that of the real stage of effusion which 
constitutes hydrocephalus. This inflammatory state may 
be ushered in suddenly by obstinate vomiting, high 
fever, thirst, heat of the surface, and especially of the 
head ; the face may be pale and alternating with flushes, 
the eyes red, pulse quick, throbbing of the temporal 
arteries, aversion to light and sound ; the head is either 
rolled about incessantly or the child lies still with an 
occasional cry of pain ; it complains frequently of its 
head — if too small to do so by words, by raising its hand 
to the head often. The appetite is lost and the bowels 
constipated ; the pupil of the eye is generally contracted 



AND GUIDE TO HEALTH. 415 

during the first stage of the disease. Sometimes a con- 
vulsion is the first symptom we notice of the disease. 

The disease, however, does not always set in so ab- 
ruptly. The first symptom sometimes is, loss of cheer- 
fulness — the child losing a taste for his usual enjoyments 
— headache, frequent knitting of the brow, occasional 
deep-drawn sighs, grinding of the teeth, with a pale, 
collapsed appearance ; disturbed rest at night, with 
sudden starlings from sleep in alarm, or with a scream ; 
the appetite soon becomes impaired, the bowels consti- 
pated ; there is more weakness in one leg than the other ; 
the temper is irritable and the head aches ; there is pain 
in the bowels, an unpleasant smell of the breath, vomit- 
ing, especially on moving, tenderness of the abdomen on 
pressure, which is not tumid but concave. All the senses 
are at first morbidly acute, but gradually lose their 
power as effusion takes place. 

The stage of effusion may be preceded by a sleep, or 
an apparent improvement of all the symptoms, which, 
however, is delusive. The delirium subsides or occurs 
occasionally ; the pupil of the eye is permanently 
dilated, and ceases to contract even on the approach of 
light. The child falls into a state of stupor from time to 
time, and, frequently an agonizing scream is heard ; the 
moaning is almost constant; the eyes are half closed, 
exhibiting a glazed appearance. The disease may last 
for several weeks, and then terminate in death by a con- 
vulsion or coma ; about three weeks is the average. 

TEEATMENT. 

The treatment in the stage of inflammation must con- 
sist of cold applied to the head by means of a thin cloth 
wet very often and drawn lightly over the head, or by 
pouring a small stream of water a short distance on the 



416 THE FAMILY PHYSICIAN 

head for a few seconds occasionally ; this, however, can 
not often he done, as the child will fret and do itself more 
injury than the operation will good. Ice pounded up 
and placed in a bladder and put to the top of the head is 
the best plan, but this must be done with some caution, 
and not applied too long at a time, or it may produce too 
great depression. The feet may be bathed in warm 
water, and kept warm by means of hot bricks, etc. 

The child at the commencement may have a full dose 
of salts and senna tea to operate freely on its bowels ; 
after this the bowels may be kept open by means of a 
syringe, at least during the stage of inflammation. The 
skin should be frequently bathed with the tepid alkaline 
sponge bath. The child must be kept in a state of 
quietude, avoiding all sources of irritation; the room 
should be darkened. The gums must be cut if teething. 

If effusion takes place the case is almost hopeless ; the 
applications may be continued to the head, feet, and 
body, as above directed, and a cathartic of compound 
powder of jalap — which is made by taking senna in 
powder four drachms, jalap in . powder one drachm, 
ginger five grains ; mix. The dose for a child three years 
old is about one-eighth of a teaspoonful, taken in milk, 
wine or cider. This may be repeated every three hours 
until a free action is had on the bowels. Iodide of 
potassium may be given to a child of two or three years 
in half-grain doses, in a teaspoonful of water, three times 
a day. A little milk should be given the child if it is not 
nursing. If it is, all the better, but if it is not, and the stom- 
ach will not take food or retain it, a little beef tea may 
be injected into its rectum several times a day. 

Children predisposed to affections of the head (and the 
head is the general seat of children's disease, while the 
chest is the part most subject in middle life, and the ab- 



AND GUIDE TO HEALTH. 417 

domen in old age) should never be given "blows on the 
head ; in fact this is a reprehensible practice, and I have 
often been led to wonder that sane, intelligent parents 
would so far forget themselves and do so great a wrong 
to the child as to give it a blow on the head, or, as an 
infuriated mother will sometimes term it, " a slap on the 
jaw." This brutality should be left exclusively for the 
animals of the P. R., who are just now so numerous 
about St. Louis. 

Many a child has been rendered an idiot by or from 
the ultimate effects of a thoughtless blow on the head 
from an angry mother, while thousands of others have 
been sent to the grave by hydrocephalus from an un- 
natural blow, even light, on the tender head. It seems 
strange that parents filled with love for their children — 
ilesh of their flesh and blood of their blood — would need 
a caution like this; but who has not seen many of 
these dear little creatures, that our blessed Saviour de- 
sired should come unto him, reel in agony and stagger 
from a blow dealt them by an unnatural parent on their 
tender heads. 

Still I know this is not often the result of any lack of 
feeling on the part of a mother, but thoughtlessness and 
a lack of knowledge as to the amount of injury such a 
blow might produce. I hope that no mother or father 
whose eye ever passes over this article will ever again be 
guilty of the criminal act of striking a child a blow on 
the head or face. 

CHRONIC HYDROCEPHALUS. 

This is rarely met with. It may occur from infancy to 
old age ; it may occur in infants before their birth. 

27 



418 THE FAMILY PHYSICIAN 

SYMPTOMS. 

The most striking feature of the disease is the enlarged 
head. In infants this proceeds rapidly, owing to the 
separation of the bones of the head or sutures ; but even 
when the sutures are ossified the enlargement has taken 
place. This increase of size is confined to the vault of 
the cranium only (upper part of the head). As the dis- 
ease progresses the senses become impaired, the pupil 
dilated, and the child finally presents the appearance of 
an idiot and sinks into indifference and coma ; convul- 
sions often takes place, followed by paralysis. 

TKEATMEOT. 

This should be the same as recommended for the effusion 
after the acute inflammation. Puncturing of the cranium 
has occasionally proved successful, and in so hopeless a 
disease, when other means have failed, maybe performed. 
Compression has also proved successful in some instances, 
but in others it has brought on convulsions. 

DROPSY OF THE CHEST. 

This term is applied to a collection of serous or watery 
fluid within the cavity of the pleura. It may exist alone, 
but generally prevails as part of a more universal dropsy. 

SYMPTOMS. 

First, oppression and difficulty of breathing is experi- 
enced, which is increased when the body is in a horizontal 
posture or on any considerable exercise. The patient 
can not lie on the side of the chest opposite to the one 
affected. He generally, in the advanced stages, assumes 
nearly the sitting posture. There is a short, dry cough, 



AND GUIDE TO HEALTH. 419 

frequent shiverings, sense of heaviness at the pit of the 
stomach, loss of sleep {insomnia), unpleasant dreams and 
sudden startings, palpitation of the heart, occasional 
faintings, &c. The affected side becomes enlarged and 
round. Upon percussion (striking) the side in which the 
fluid exists will have a dead sound, like striking the 
thigh or any solid flesh. When the patient is erect, sit- 
ting or standing, the fluid goes down. 

CAUSES. 

Cold, injuries or obstructions to the circulation, want 
of proper nourishment, general debility, long protracted 
fevers, &c. But one great cause of this form of dropsy 
is the intemperate use of spirits, especially among beer, 
gin and whisky drinkers. Inflammation of the pleura 
also often gives rise to it. 

TEEATMENT. 

Diuretics, hydragogue cathartics, tonics and nutrients 
are the means, in connection with sudorifics and a proper 
attention to the skin. The hydragogue cathartic may 
consist of jalap fifteen grains, cream of tartar thirty 
grains, podophyllin half a grain. Administer this for a 
dose and repeat it every six hours, if the patient is able 
to stand it ; if not, only two or three times a week. For 
a diuretic the patient may use ten grains of nitrate of 
potassa three times a day, or two teaspoonfuls of spirits 
of nitre three times a day. For a tonic, tincture of Peru- 
vian bark or tincture of iron. For the sudorific influence, 
if he is able, the spirit vapor bath may be used two or 
three times a week, and at night Dover's powders. I 
again wish to call attention to the sustaining plan, which 
becomes doubly necessary in this case, as the medication 
is calculated to lower ; the very best nutritious diet must 



420 THE FAMILY PHYSICIAN 

be had, but it must be easy of digestion ; fluids should 
be taken very sparingly. Thirst may be quenched by 
using little lumps of ice, or by taking cold water in 
small quantities. 

Moderate exercise must be taken, and every means 
employed to promote the general health. 

Sponge baths should be taken daily. A gin " egg 
nog " may be indulged in three times a day. 

The tonics must be used long after the water disap- 
pears, to prevent a relapse. 

DROPSY OF THE ABDOMEN— ASCITES. 

This disease consists of a collection of water in the 
peritoneal sac, or the general cavity of the abdomen. It 
is sometimes, however, found between the peritoneum 
(or the membrane that lines the inside of the abdomen) 
and the muscles of the abdomen ; it is also sometimes 
found in sacs upon or connected with some of the viscera, 
as the ovaries, liver, &c. It is then termed encysted 
dropsy. Ascites may occur in either sex, or at any age, 
but is, like other forms of dropsy, chiefly met with in 
persons of advanced age. 

SYMPTOMS. 

Dropsy of the abdomen occasionally commences by 
what is called cellular dropsy, especially of the lower 
extremities. But it is generally preceded by a dry skin, 
cough, loss of appetite, oppression at the chest, costive- 
ness and a scanty urine. In a short time a slight enlarge- 
ment of the abdomen is observed, with a disagreeable 
feeling, and some tenderness when pressure is made ; 
the whole abdomen then becomes uniformly swollen 
and tense. 



AND GUIDE TO HEALTH. 421 

Difficulty of breathing is experienced when a horizon- 
tal posture is maintained ; the face is pale and bloated, 
pits on pressure ; the thirst is great, the stomach and 
bowels are deranged; colic pains are frequently felt. 
By applying one hand on one side of the abdomen, while 
the patient is sitting or standing, and striking gently on 
the other side with the tip of the fingers of the other 
hand, a distinct fluctuation will be felt ; sometimes it 
can be detected by the ear. 

TKEATMENT. 

This must be conducted much in the same manner as 
that for dropsy of the chest. 

The diuretic — the nitrate of potash, in ten grain doses, 
three times a day, or spirits of nitre, or the hydragogue 
cathartic ; the jalap fifteen grains, cream of tartar thirty, 
and half grain of podophyllin, every six or twelve hours, 
or as the patient is able to bear it ; the spirit vapor 
bath, sponge bath, and the Dover's powders at night ; 
and particularly the tonics of Peruvian bark, and the 
nutritious diet, egg-nog, &c. 

In addition to all that has been said on the treatment 
of dropsy of the chest, in this (dropsy of the abdomen), 
when the water begins to recede from the abdomen, a 
bandage must be applied arourid it, loose at first, but 
gradually made tighter, so as to support the abdomen ; 
this must be worn for sometime after the water has all 
disappeared. It is often the case that after the water has 
passed out, and in fact before, the abdomen seems ten- 
der ; when this is the case a liniment of oil of origanum 
two drachms, aqua ammonia four drachms, alcohol six 
drachms, and sweet oil two ounces — mix — should be 
applied once or twice a day, for several weeks, over the 
whole abdomen. 



422 THE FAMILY PHYSICIAN 

In all other respects follow the directions given for the 
treatment of the dropsy of the chest. After the water 
has been removed from the chest, and the cathartics 
stopped, the bowels may be kept open by the use of the 
syringe. 

CELLULAR OR GENERAL DROPSY— ANASARCA. 

This disease consists of a collection of flnids in the 
cellular membrane of the external parts of the body — 
chiefly beneath the skin. 

It may be of the lower extremities or it may be of the 
whole body. The swelling is always regular and uni- 
form, and of a soft feel, leaving a pit or depression when 
pressed upon by the finger, which slowly returns to its 
former fullness. 

SYMPTOMS. 

Swelling of the feet and ankles is usually the first 
symptom noticed in this form of dropsy, which increases 
in the evening, particularly if the patient has been 
standing or walking considerably. This swelling at 
first, generally, partly disappears by morning, or when 
a recumbent posture has been maintained for some 
hours. The swelling is soft, elastic, and pits upon pres- 
sure. The skin looks paler than usual. The swelling 
gradually extends up to the body, and then over the 
whole body, even the eyelids becoming swollen. Occa- 
sionally the fluid oozes out through the skin, or raises 
the skin in elevations, resembling a blister. 

The countenance is sallow, the bowels costive, the skin 
dry and shining, with more or less thirst. As the dis- 
ease progresses there is a sensation of general debility, 
with sluggishness and inactivity, and a slow fever. 

When the watery accumulation becomes general the 



AND GUIDE TO HEALTH. 423 

vascular and cellular structures of the lungs become 
affected, occasioning difficulty of breathing, coughing, 
and a watery expectoration. 

CAUSES. 

Upon the causes of this form of dropsy the treatment 
will much depend. It may be caused by any circum- 
stances that will produce a debilitated state of the body ; 
but this fact affords one valuable suggestion in regard to 
its treatment, i. e., it is caused by debility, and in order 
to effect a cure a different state of affairs must be pro- 
duced or brought about. 

It frequently follows febrile or inflammatory attacks. 
Chills and fever, when permitted to run for a long time, 
often produce anasarca, also excessive hemorrhage, 
chlorosis, and the excessive use of alcoholic drinks. 
Sometimes it is owing to disease of the heart, spleen or 
liver. 

TKEATMENT. 

As above hinted at, this must depend to some extent 
upon the cause. If it is owing to intemperance, no cure 
can be had until that habit is stopped ; if from chills and 
fever, they must be stopped ; if from any diseased organ, 
attention must be given it at the same time the water is 
being removed, or very soon thereafter. 

The means for removing the water are the same as 
recommended for dropsy of the chest. A bandage should 
be used around the feet, ankles and legs as soon as the 
water begins to recede from them, and applied tight, 
renewing it two or three times a day. 

Careful examination should be made, and the history 
of the case well looked up, so that the cause may be 
ascertained ; and if caused by the presence of any dis- 
ease, that it may receive early attention. 



424 THE FAMILY PHYSICIAN 

This form of dropsy, above all others, requires a sus- 
taining treatment, while it is necessary to purge and give 
diuretics to get rid of the accumulation of water. The 
system must be sustained by the most judicious course 
of diet, stimulants and tonics. 

The general health must be well looked after ; feeding, 
exercise and bathing must be attended to carefully and 
perseveringly. 

DROPSY OF THE SCROTUM— HYDROCELE. 

This is a collection of water in the scrotum or bag 
which contains the testicles ; it may be in some part of 
the testicle itself, or spermatic cord. It is not a dangerous 
disease. 

SYMPTOMS. 

A smooth, soft, elastic, and often transparent swelling 
commences in the lower part of the scrotum and gradu- 
ally extends upward. The tumor finally becomes some- 
what pear shaped, and feels like a bladder filled with 
water. No pain is produced by pressure, unless the 
testicle be compressed. A fluctuation of water can be 
discovered. 

TKEATMENT. 

This may ,be done by tapping and bringing away the 
water. This is sometimes practiced, but it is hot the 
proper course and will seldom make a cure. It is best to 
use the remedies recommended for other forms of dropsy, 
and try to carry the water away in that manner. This 
can almost always be done, but if not, tapping will be- 
come necessary. My practice has been to treat the 
patient for a few days, or a week or two, then if the water 
was not beginning to be removed to tap and draw it off. 



AND GUIDE TO HEALTH. 425 

This may be done with a common lancet. Be sure, how- 
ever, that it is dropsy of the scrotum and not 7iernia, for 
it would be a serious affair if, by cutting into it, you 
should cut the bowels, which would be the case were it 
hernia. But this mistake need never be made, as water 
can always be detected when present. After drawing off 
the water continue the treatment as recommended for the 
other forms of dropsy, and it will not be likely to return 
again; if it does, however, tap again. Under this 
treatment I have never had it to fill above the second or 
third time. • % 

I don't like the plan of injecting some stimulant into 
the scrotum to produce an inflammation, causing the 
scrotum to adhere to the testicles, thereby leaving no 
cavity for the water. This is the popular practice. 

DROPSY OF THE HEART— HYDROPERICARDIUM. 

In this affection there is an effusion of water into the 
pericardium, or the membranous sac around the heart. 
The symptoms in many respects resemble those of dropsy 
of the chest, and in fact it is not always that it can be 
determined from that disease. 

Causes similar to those producing dropsy of the chest, 
or hydrothorax, will produce it ; and the treatment is the 
same. 



426 THE'FAMILT PHYSICIAN" 



IEURALGIA. 



This is a painful disease of the nerves, particularly the 
sensory nerves. The pains are sudden in their com- 
mencement, following the course of the nerves. They are 
of a darting, stabbing, boring, burning character, and 
are at first unattended with any local change that can be 
recognized. They are always intermittent, sometimes 
regularly and sometimes irregularly so. The periods of 
intermission are distinguished by complete freedom from 
acute suffering, and in recent cases the patient appears 
quite well at these times. 

The word neuralgia has a general recognized force, 
and there is no equivalent to it which represents the 
whole group of disorders to which it applies, though 
there are numerous phrases for particular forms of the 
disorder. 

SYMPTOMS. 

Pain along the course of a nerve, generally the nerves 
of the face, though it is met with in different parts of the 
head, in the breast, side, hip-joint, and other parts of the 
limbs. Its attacks are usually sudden, and the paroyxsm 
of pain varies in its duration. The pain is agonizing, 
lancinating, and shoots along the nerves, frequently feel- 
ing as if red-hot wires were thrust into the parts. After 
the pain passes away a feeling of numbness remains for 
some time. 



AND UTJIDE TO HEALTH. 427 

The pain occurs from time to time, at longer or shorter 
intervals, and is often produced by the most trifling 
causes. If not cured the system suffers, gets lower and 
lower, until the patient dies, worn out from the repeated 
shocks. 

The symptoms vary greatly in different cases of neu- 
ralgia, according to the variety of the disease (of which 
there are several), still there are certain features which 
are observed in all true neuralgias. " In the first place," 
observes Sir Francis Edmund Ansite, " it is universally 
the case that the existing condition of the patient at the 
time of the first onset of the disease is one of debility, 
either general or special." Says the same author, "An- 
other circumstance is common to all neuralgias of super- 
ficial nerves ; and as a large majority of neuralgic 
affections are superficial in situation, this is, for practical 
purposes, a general characteristic of the disease. I refer 
to the formation of tender spots at various points where 
the affected nerves pass from a deeper to a more super- 
ficial fibrous fasciae. So general is this characteristic of 
inveterate cases that Valleix founded his diagnosis of the 
genuine neuralgia on the presence of these painful 
points." The third general characteristic of neuralgic 
affections are, that the pain is intermittent, or at least 
remittent, in every stage of the disease. 

The fourth general characteristic is, that fatigue and 
every other temporary depressing influence directly pre- 
disposes to an attack of acute pain, and aggravates it 
when already existing. 

CAUSES. 

Neuralgia may be caused by any thing that will pro- 
duce general depression, or even temporary depression ; 
a sudden shock, as of a fall, railroad accident, or any 



428 - THE FAMILY PHYSICIAN 

thing that gives a jar to the central nervous system, or 
by severe mental emotion. Or it may be produced by 
direct violence to the nerves, by cutting, or by bruising 
wounds, by a local inflammation — as the eye — or by a 
decayed tooth, or any thing that is calculated to injure 
the nerve. Neuralgia in the face is oftener produced by 
a decayed tooth than in any other way. 

TKEATMENT. 

Dr. Ansite observes, " The treatment of neuralgia 
may be classified under three heads : The first division 
includes all remedial measures which are intended to 
improve the general nutrition, including that of the 
nervous system, or to remove any vicious condition of 
the blood which may impair nervous function. The 
second division includes the narcotic stimulant remedies. 
The third division comprises all the remedies which are 
destined to exert a direct influence upon the affected 
nerve." 

Under the head of nutritive remedies for neuralgia by 
far the most important sub-class is the series of animal 
fats. There is theoretical basis for the use of these sub- 
stances which it is impossible to ignore. 

If we take, for instance, the class of neuralgia which 
is most plainly and indubitably connected with im- 
paired nutrition— -those of advanced life, and particu- 
larly the inveterate forms of facial tic douloureux — there 
is the strongest ground, in the result of experience, for 
insisting upon the value of this kind of remedies. 

Dr. Ratcliffe says, " It will be found that neuralgia 
patients have cherished a dislike to this class of (fatty) 
food of all kinds, and to have systematically neglected 
its use." And Dr. Ansite observes, that he has also 
obtained strong evidence that this is the general rule, 



AND GUIDE TO HEALTH. . 429 

and the reverse a rare exception. And it has several 
times occurred to him (Dr. Ansite) to see patients entirely 
lose neuralgic pains, which had troubled them for a con- 
siderable time, after the adoption of a simple alteration 
in their diet, by which the proportion of fatty ingredients 
in it was considerably increased. 

Cod liver oil occupies the highest rank among fatty 
remedies ; when it does not immediately disagree with 
the stomach this oil is the best fat to employ. But in 
other cases butter, and especially cream, may be em- 
ployed with great advantage ; " and, in fact," says Dr. 
Ansite, " one of the most successful examples of the 
treatment of neuralgia, which I record, was treated 
solely by the administration of Devonshire cream, in 
increasing, and, finally, in very large quantities." Even 
the vegetable olive oil, though far inferior to animal fats? 
as a general rule, may occasionally be used with good 
effect. It is necessary in many cases to make a series of 
trials before we arrive at the particular form of fatty 
food which is best suited to the particular patient. 

Iron, in any of its preparations, is only of use in 
cases of actual anaemia (lack of blood) ; in this the car- 
bonate is the best form. The employment of the so- 
called nerve-tonics is of great use in some cases ; of none 
at all in others. Quinine, arsenic and zinc are the only 
medicinal substances of this class which possess any 
solid claim to efficacy. 

With regard to the efficacy of quinine there are the 
most conflicting opinions, except in one respect. No one 
doubts that in the neuralgias which are of malarious 
origin this medicine, though not infallible, is extremely 
efficacious. 

It should be administered in all cases, which from 
their regular intermittence leave room for a suspicion 



430 THE FAMILY PHYSICIAN 

that this may Ibe their nature, in full doses, from five to 
ten grains, repeated two or three times during the inter- 
mission — just as you would do in regular chills and fever. 

In a great number of non-malarial cases quinine also 
produces good effects ; hut there is no need 3 nor is it ad- 
visable, to employ it in such large doses. From two to 
three grains two or three times a day is quite enough. 
Quinine is said to be more useful when the neuralgia is 
in the ophthalmic branches of the fifth nerve (i. e., the 
branches about the eye) than it is in any other non-mala- 
rial form. Arsenic is a more widely applicable remedy, 
for it is useful in almost all cases, both of the malarial and 
non-malarial type. In the former it should be given in 
full doses — ten drops of Fowler's solution three times a 
day. This dose may be increased one drop a day until 
it gets up to fifteen drops. In the non-malarial forms 
half that quantity will suffice. The ordinary precautions 
must, of course, be observed as in other cases where we 
employ arsenic. If any of the disagreeable symptoms 
appear that it is known to produce, such as burning in 
the stomach, &c, it must be discontinued at once. But 
arsenic is a safe remedy in such doses. The sulphate of 
zinc enjoys the confidence of some practitioners, but I 
hardly think it worth mentioning. If neuralgia arise in 
a syphilitic patient it may be treated with iodide of po- 
tassium, or in gouty patients with wine of colchicum. 

"We now come to notice the narcotic stimulant reme- 
dies for neuralgia — opium, belladonna, alcohol, am- 
monia, etc. "We know that these articles, when given 
in certain small doses, possess the common property of 
assisting nervous function, and of paralyzing it if given 
in large doses. 

" Indisputably," says Ansite, " at the head of all this 
class of remedies stands opium." And we may consider 



AND GUIDE TO HEALTH. 431 

opium, as used against neuralgia, to Ibe fully represented 
for every useful purpose by morphia. But opiates 
administered "by the stomach can, after all, be only con- 
sidered as palliative. 

The invention of the subcutaneous injection has thrown 
quite a new light on the capabilities of opium as an anti- 
neuralgic. It may be confidently said that in the right 
use of this remedy we possess the means of permanently 
and rapidly curing very many cases and of alleviating, 
to a degree quite unknown before, the suffering caused 
by even the most inveterate forms of neuralgia. 

Belladonna, in doses of one-sixth to one-half grain, is 
said to relieve ovarian dysmenorrhea, as also some forms 
of superficial lumbo — abdominal neuralgia. 

But belladonna is also best given by subcutaneous 
injection. The plan is to inject from one one-hundred 
and twentieth to one-eightieth of a grain. The dose to 
be injected of morphine is, one sixth of a grain, to be 
increased if necessary. This may be injected at any 
locality, wherever a fold of skin can be conveniently 
picked up. Dr. Reynolds recommends the Indian hemp. 
A good extract of this, in doses of from one-fourth to 
half a grain — rarely a grain — given in pill is very effective 
in some forms of neuralgia. It should be given every 
night whether there be any pain or not. 

Muriate of ammonia is an excellent stimulant, and 
should be given in ten to twenty grain doses when it is 
required. 

Sulphuric ether is said by Dr. Ansite to be a superior 
remedy in visceral neuralgias. It sometimes relieves 
gastralgia and neuralgia of uterine or ovarian origin; 
for the purely nervous form of angina pectoris it has no 
equal. 

Alcoholic drink is a valuable article in the treatment 



432 THE FAMILY PHYSICIAN 

of neuralgia ; but to be useful it must be, like opium, 
taken in small quantities. It may be dangerous to pre- 
scribe brandy or wine for this complaint, for the reason 
that the patient may indulge too freely, and drink not 
only to ease the pain by using stimulating doses, which 
really are of service, but they accustom themselves to 
drowning the pain with a larger narcotic dose, and thus 
contract a liking for the oblivion of drunkenness ; but 
to a patient that can be trusted it is useful in moderate 
doses. 

Sugar, or saccharine liquors and saccharine food, ex- 
cept in very moderate quantities, do not agree with neu- 
ralgic patients. 

Of external applications, blistering has its advocates ; 
but I doubt its utility, in fact fear it is a positive injury. 
I never thought blistering good policy when the nerves 
were irritable ; still there is good authority for blistering, 
especially over the origin of the affected nerve. The 
chloroform liniment will often prove useful. Take of 
chloroform one ounce, sweet oil six ounces, and mix. 
This may be applied freely along the course of the 
nerves. 

Nutrition should be good ; it is absolutely necessary 
this should be as abundant as possible without deranging 
digestion. It must also contain a liberal amount of fatty 
matters. No amount of dislike on the patient's part — 
and they often show great dislike — should induce the 
physician to give up this point. If one form of fat can 
not be tolerated another must be tried. Equally important 
is the avoidance of exposure to cold and damp air with 
insufficient clothing. Flannel underclothing, thick veils 
for the face, etc., are quite as important as medicine. 
The general health must be attended to. 



AND GUIDE TO HEALTH. 433 



DELIRIUM TREMENS. 



A disease brought on by the intemperate use of alco- 
holic drinks. 

SYMPTOMS. 

The first warning of the approach of delirium tremens 
is ordinarily given by the occurrence of complete insom- 
nia (absence of sleep). The patient may have long 
indulged to excess in drink, or he may be quite a novice 
in intemperance, but in any case a greater debauch than 
usual has commonly been perpetrated ; and the sufferer 
finds himself quite unable to obtain any sleep. It used 
to be believed that, in the majority of cases, the delirious 
effects were produced, not by the direct poisonous action 
of alcohol upon the nervous system, but by the circum- 
stances of an habitually intemperate person leaving off 
the use of his accustomed potations. This is a mistaken 
idea, for patients are often attacked during a debauch, 
in fact, I may say always ; for the leaving off drink for a 
day or two before the symptoms are developed is in con- 
sequence of the commencement of the disease. They 
exhibit a repulsive feeling to strong liquors, which is, 
indeed, a part of the early symptoms of the acute dis- 
ease. The short snatches of slumber the patient gets are 
disturbed by horrifying dreams and visions ; and during 
his waking moments, even in broad day light, he suffers 
from hallucinations of sight, which commonly take the 

form of disgusting or terrifying objects, such as snakes, 
28 



434 THE FAMILY PHYSICIAN 

insects, monsters, or of armed men pursuing him with 
threatening gestures. 

Often the occurrence of distinct visual hallucinations 
while the patient is awake is the first sign of the passage 
from chronic alcoholism, which may have lasted for 
months or years, with a varying degree of insomnia, and 
habitual distressing dreams, to the acute affection. 

During the first day or two the patient is much de- 
pressed, with slow and feeble pulse, cold extremities and 
a profuse sweating. The mental state is one of great 
anxiety, but there are usually no real delusions ; even 
when visual hallucinations are present, the patient 
can, by an effort of the will, recognize them as such, and 
momentarily banish them from his sight. During all 
this time there is a complete want of appetite — no food 
is taken ; this circumstance precipitates the second, in 
which the mere anxiety is exchanged for incoherence of 
speech and wild excitability of manner, which sometimes 
takes the shape of causeless anger (though even then 
often mixed with cowardice), and . sometimes of great 
terrors, which the sufferer often accounts for by point- 
ing to imaginary terrific shapes that seem to fill the 
room, and which he is constantly seeking to push aside 
with a restless motion of his hand. He talks incesantly 
in a rambling fashion. 

He may generally be restrained to some extent by any 
looker-on who will speak to him in a firm voice, and he 
may be for a time partly reasoned out of his hallu- 
cinations. 

The pulse is now quick, from 100 to 140 a minute ; it 
is small and thready, but sometimes may be soft and 
voluminous ; it resembles pulse in a typhoid type. 

Muscular tremor, which, from its striking prominence 



AND GUIDE TO HEALTH. 435 

in many cases lias given the disease its name of delirium 
tremens, is by no means universally present. 

The face is generally flushed, but sometimes pale ; 
sweating is nearly always present ; the tongue is tremu- 
lous ; its color varies. 

This second stage may last two or three days, or lon- 
ger, when we have what is called the sleeping stage, or 
critical stage, as it is termed by some. 

At this period the patient falls into a continuous 
slumber, which, if it be sound and natural, is expected 
by some to be a sure sign of convalescence. This sign, 
however, is of no importance, for numerous cases have 
been observed in which the patient has sunk into pro- 
found slumber for many hours and has awakened as 
delirious as ever, or in a state of complete prostration, 
which rapidly terminated in death. 

Sleep marks the commencement of convalescence only 
when we find the patient on waking clear in his intellect, 
free from hallucinations, or nearly so, and with a pulse 
greatly reduced in frequency. But, instead of sleep oc- 
curring at all, the patient may pass from mere delirium 
into a comatose condition, with mutterings, eyes open, 
soaring and fixed, picking at the bed clothes, or possibly 
stertorous coma, or violent convulsions, these symptoms 
being followed speedily by death. 

In other cases, in the midst of violent delirium with 
great excitability, collapse suddenly takes place, the pulse 
becomes hurried and intermittent, the features pinched 
and ghastly, the breathing gasping, and death ensues in 
a minute or two. 

TKEATMENT. 

It has been but a short time since the opinion univer- 
sally prevailed that the delirious symptoms were owing 



436 THE FAMILY PHYSICIAN 

to the exhaustion, which was chiefly kept up by the want 
of sleep, and consequently that the production of con- 
tinuous sleep for several hours was the sole and all-im- 
portant means of cure. It was, therefore, the custom to 
ply the patient with larger and larger successive doses 
of opium, with a view of drowning the delirium in narcotic 
stupor. Great mischief arose from this wide-spread 
belief and practice. In the first place, it has often 
happened that the patient, without ever sleeping at all, 
has passed first into a state of coma-vigil, next of ster- 
torous breathing, and at last sunk, fairly poisoned with 
opium. 

Again, a fact which was disregarded by the earlier 
authorities was this — that, without exerting any poison- 
ous action upon the centres of consciousness, opium 
occasionally spends almost the whole of its depressing 
force upon the visceral nerves. A minor consequence of 
neglecting this fact was, that the patient's chance of 
assimilating food was often entirely ruined by the par- 
alysing action of the drug upon the digestive organs. A 
much more serious one was the accident, which has 
doubtless happened, and which Dr. Francis Edmund 
Ansite, one of the most eminent writers of the age on this 
subj ect, says has occurred in cases within his knowledge — 
viz. : " the rapid induction of cardiac paralysis, the patient 
(without any cerebral signs of poisoning whatever) sud- 
denly becoming ghastly pale, the pulse fluttering and 
coming to a stand still within a few moments." 

The idea that patients in delirium tremens require to 
be narcotized into a state of repose may now be said 
to be abandoned by those best qualified to speak on the 
subject. In fact, the condition of the brain requires that 
sort of treatment which shall fortify and stimulate its 
functions. Every stimulant, when given in such doses 



AND GUIDE TO HEALTH. 437 

as alone to deserve that name, is a promoter, bnt not an 
exhauster, of function, and the idea of any depressive 
recoil following its action is purely fictitious. There are, 
accordingly, a great number of remedies, of which the 
larger doses are narcotic, and the smaller stimulant, 
which in the latter form are capable of giving more or 
less relief to the symptoms of delirium tremens. It is 
not worth while to enumerate all these. The typical 
member of the group in stimulants is easily digested 
food ; and the successful treatment of delirium tremens, 
in nine cases out of ten, depends on the regular and con- 
tinuous supply of suitable nutriment, whereby the 
functions of the nervous system are supported during 
the struggle toward recovery. The principal kinds of 
food which are desirable are, milk, soup, or strong broth, 
with bread in it (and given very hot), beef tea, rice, and 
some of the concentrated meat food, and raw egg, beaten 
up well, diluted a little with water and sweetened enough 
to make it palatable. The necessity for the administra- 
tion of some nutriment of this kind is imperative ; and 
if the stomach at first be too irritable for it, it must be 
given by injection, so as not to lose a day, nor even a few 
hours. If the patient be young and robust, it will be 
well to give him a purgative of citratized magnesia, or 
salts and senna ; let the dose be a full one if a large 
quantity of spirits has been drank. It is a well known 
fact that large quantities of alcohol are actually taken 
into the circulation ; by the purgative it will be eliminated 
to some extent. When the strength of the patient is 
sufficient to allow of this plan being safely carried out, 
it will be found that the subsequent assimilation of food 
is rendered more easy and rapid, and that the stage of 
convalescence is comparatively soon attained. But in 
debilitated subjects this plan is not to be attempted ; 



438 THE FAMILY PHYSICIAN 

with them commence at once with the administration of 
the more easily digested foods, in small quantities, fre- 
quently repeated. 

The irritation of the stomach may be combated by the 
administration of ice and of small quantities of soda 
water. One of the best modes of commencing feeding is 
by the administration of milk, mixed with one- third of 
its bulk of lime-water ; give it in small quantities at 
frequent intervals. 

I will not stop here to argue the moral of giving alco- 
holic drinks in delirium tremens, but say that those who 
have been long in the habit of depending on alcohol for 
a large part of their nutrition must have it, to a limited 
extent. Opium or morphine in small doses will generally 
be required — not, however, in large doses. Morphine had 
better be used in only one-fourth grain doses, three times 
a day; it ought to be used only by hypodermical 
injections. 

I come now to mention an article that must soon take 
its stand at the head of all others for the treatment of 
delirium tremens, in connection with nutritious food, viz. : 
bromide of potassium, in twenty-grain does, repeated 
every two or three hours, until sleep occurs. 

This article seems to better fulfill the indications than 
any other yet tried. 

Tartar emetic has been used and recommended, but 
my advice is, never touch it. Also let chloroform and 
digitalis have a wide berth. They are- not adapted to 
general use in this complaint. 

To the patient I would say, let your sufferings and 
dangers be a warning. Never, never humiliate yourself 
again in this manner. It is degrading to every feeling 
of refinement; and remember that a drunkard's couch 
is not a good place to start to heaven from. 



AND GUIDE TO HEALTH. 439 



PILES-HEMORRHOIDS. 



Piles consist of tumors seated at or near the verge of 
the amis, which, when ulcerated, are liable to bleed at 
each effort to evacuate the bowels. 

CAUSES. 

The local causes of piles may be any thing that will 
create engorgement and distention of the hemorrhoidal 
veins, as straining from constipation, pregnancy, constant 
sitting on warm cushions, or hardened excretory matter 
remaining too long in the lower bowels ; or the excessive 
use of tobacco, which, relaxing the anal muscles, favors 
congestion of the part, in a plethoric habit ; or the con- 
gestion created by irregular menstruation may act as a 
predisposing cause. 

SYMPTOMS. 

As hemorrhoidal tumors are due to vascular changes 
in the rectum, which induce inflammatory and neuralgic 
irritation, the earliest symptom of their presence is a 
sense of fullness and irritation, or soreness about the 
anus, which is especially marked for an hour or so after 
an evacuation. Soon these symptoms become distinct, 
creating the sensation of a foreign body being in the 
rectum, and giving rise to a feeling of dissatisfaction, or 
a repeated desire to stool; the pain extending back 
toward the sacrum and spine, or toward the bladder 



440 THE FAMILY PHYSICIAN 

and down the thighs, from the nervons connections of the 
part. The feces are now sometimes streaked with "blood, 
or the paper is tinted, or about a teaspoonful of blood 
escapes toward the end of the stool ; itching is also 
developed near the anus, this being often due to ecphyma, 
while the parts are constantly moist, and the linen soiled 
with pns or blood. The escape of blood generally gives 
temporary relief, but, if often repeated, creates weakness. 
At the next stool the tumors may be more engorged, and 
the patient will recognize their presence with the finger. 
If they continue to be constricted by the sphincter ani, 
or if any irritation increases the afflux of blood to them, 
they will then be more tumid, hot and painful ; and, if 
now inspected, will be found to be violet-colored, smooth, 
shining, and exquisitely painful to the touch. As the 
irritation continues the sphincter ani participates in it 
and contracts spasmodically, causing the patient to 
scream violently with the shooting character of the pain, 
while evacuating the bowels creates horrible torture ; the 
tumor then becoming much blacker and larger, and ter- 
minating sometimes — if left unreduced — in ulceration of 
the part after a day or two. Sometimes, on the contrary, 
the spasm passes off, and the tumor is then less engorged, 
until, after forty-eight hours, it is quite flacid, and the 
patient may be comparatively comfortable, or only suffer 
at the period of evacuations. The constricted condition, 
with the irritation and intense suffering just described, 
is usually said to be due to a " fit of the piles." 

The long continuance of hemorrhoids usually causes 
great disorder of the digestive, circulatory and nervous 
functions ; the patient being liable to dyspepsia, flatu- 
lence, colic and a sense of constriction, or sinking about 
the navel, while he is troubled with palpitation of the 



AND GUIDE TO HEALTH. 441 

heart, a quick, irritable pulse, and general symptoms of 
weakness. 

Not unfrequently Ms entire moral character is changed, 
becoming cross, peevish, irritable and irrascible, quarrel- 
ing with every one, and not unfrequently resorting to 
the use of alcoholic drinks or opium to deaden his sen- 
sibility, which only adds to the difficulty. 

TKEATMENT. 

The treatment of piles may be either palliative or 
radical. The palliative consists in administering, every 
day, before the patient goes to stool, an injection of a 
full pint of cold fiax seed tea, or of cold water — though 
the first is preferable. Then the parts, after defecation, 
should be well bathed in cold water, the bowels kept 
free by mild purgatives, and some of the balsams or 
terebinthinates be occasionally administered. 

The following is a valuable remedy when the tumors 
ulcerate and bleed ; it's action is directly on the mucous 
membrane : Turpentine emulsion, one ounce ; balsam of 
copaiba, one ounce ; honey, two ounces. A tablespoon- 
ful at bed-time each night until the bowels become free 
and the irritation is relieved. 

If the tumors are external, a wash of tannin, sugar of 
lead and laudanum will give some relief. 

I have frequently known the use of an egg, well beat, 
and mixed with a little water and sugar, and sometimes 
a little good wine, taken in the morning soon after get- 
ting out of bed, to regulate the bowels. If one a day is 
not enough, it may be repeated one, two, three, or 
four times a day. If persevered in it will finally get the 
bowels into a soluble state, at the same time giving tone 
to them and the general system. I have known a case 
of piles of over ten years' standing cured by this simple 



442 THE FAMILY PHYSICIAN 

course alone. It is always worthy of a fair, patient trial # 
The radical treatment of piles consists in destroying 
the tumors in patches by the use of nitric acid or other 
caustics, or in their entire removal by the wire ligature 
or the scissors. 

Strong nitric acid, when applied for the relief of piles, 
as suggested by Houston, of Dublin, is especially appli- 
cable to those cases in which there is much bleeding, 
with marked ulceration and thickening of the mucous 
coat over the pile. It proves useful by its caustic effects, 
inducing sloughing, and subsequently the cicatrization 
of the ulcer. It also changes the action of a chronic 
swelling or induration of tissue, so as to cause the effused 
lymph to serve the purposes of healthy organization, 
instead of creating a diseased enlargement in the con- 
nective tissue around the veins. In applying it the piles 
may either be protruded, or else the rectum be dilated 
by means of a glass speculum with an opening in its 
side, the opening being turned to the tumor ; then with a 
camel's hair pencil dipped in a little of the strong acid 
touch the tumor in a longitudinal direction, so as to 
destroy entirely the vitality of the part touched, without 
permitting the acid to spread to the adjacent parts. In 
order to do this best, but a few drops of the acid should 
be put upon the brush, and the adjacent parts should be 
previously painted with sweet oil, with which the cauter- 
ized portion should be washed immediately after the 
application of the acid. 

The advantages claimed for this treatment by Houston 
are — safety from hemorrhage, and contraction of the 
vessels and tissues consequent on the separation of the 
slough. The objection to its use is the continuance of 
severe pain when the cauterization is not sufficient to kill 



AND GUIDE TO HEALTH. 443 

the parts, or when any portion of the acid escapes on 
the skin at the verge of the anus. 

Thweatt, of Virginia, and quite a number of other 
surgeons of the United States, have treated piles success- 
fully with the nitric acid. Cooke, of England, has also 
related, in the London Medical Times and Gazette, a 
number of cases of piles cured under the use of the nitric 
acid. He applied a little lint dipped in the acid to the 
pile, and pressed it there for fifteen or twenty minutes ; 
during this time the pain was severe, though the cures 
were rapid. 

The ulcer left by the separation of the slough requires 
the treatment of an ordinary ulcer. 

I have neither space nor inclination to go into a de- 
tailed account of the treatment by excision, or by the 
wire ligature. They sometimes — or at least the former 
— may become necessary and practicable, but I deem the 
directions above given sufficient, and in every respect 
preferable. The dangers that have been incurred in the 
excision of piles and the suffering consequent on the 
ordinary method of applying the ligature are facts that 
every experienced surgeon must have frequently noted. 



444 THE FAMILY. PHYSICIAN 



GRAVEL AND STONE. 



By the term gravel we understand a collection of sand 
or small particles of stone in some part of the body, in 
the kidneys, ureter, or bladder. 

CAUSES. 

The waste or disintegrated portions of the system are, 
to a great extent, carried off in a solid state in the urine, 
under the form of several acids, alkalies, calcareous 
earth and other substances ; but from irregularities in 
diet, or from disease, one or more of these matters may 
exist in excess and will be deposited at the bottom of 
the urine voided, after it has stood for a short time. 
Occasionally, however, the accumulation of these mat- 
ters becomes so great that the deposit occurs in the 
kidneys or some part of the urinary organs, from whence 
it passes into the bladder, thus giving rise to gravel. In 
perfect health no deposit is found in the urine. Gravel 
is formed in the kidneys, of varied chemical compositions, 
though it generally consists of uric, oxalic, or phosphoric 
acids, with certain salts, such as lime, ammonia, magne- 
sia, soda, silica, iron, etc.; or with a peculiar substance, 
recently described under the name of cystine. 

Among the causes of this complaint may be reckoned 
a vitiated action of the kidneys, hereditary predisposi- 
tion, the father and son for many generations laboring 
under the complaint. The continued use of hard cider 
is said to be a cause of gravel. 



AND GUIDE TO HEALTH. • 445 

SYMPTOMS. 

As it is apparent that calculi originates in the kidneys, 
the earliest symptoms of the tendency to the formation 
of these bodies will usually be found in connection with 
this gland ; thus there will be pains in the loins, this 
pain being at times much more severe than at others, 
and resembling when at its height the pain of colic, for 
which it may be mistaken, particularly when accompa- 
nied, as it sometimes is, with vomiting, and a peculiar 
sense of constriction in the region of the stomach, as if 
the patient was bound around that organ with a cord, 
the urine being scanty and high colored, and often mixed 
with blood. There is also very apt to be a burning sen- 
sation in the urethra, due to sympathetic irritation. 

When gravel or a pebble passes into the ureter, if its 
size is such as to present any obstacle to its free passage, 
a new train of painful symptoms is rapidly developed ; 
thus there will be pain in the course of the ureter, violent 
spasmodic contraction of the cremaster muscle, the testi- 
cle being often drawn quite up to the external abdominal 
ring, a fact which is of much value as a means of diag- 
nosis ; while if these symptoms continue for from twenty 
four to forty-eight hours, there will very often be present 
more or less febrile reaction, heat of skin and diminished 
secretions, this condition being usually terminated by 
sudden relief. This relief is caused by the passage of 
the stone to the bladder, and is another valuable diag- 
nostic symptom. "When the stone has thus passed to 
the bladder there is difference to be observed in the 
symptoms, in urinating the stream being frequently and 
suddenly arrested by the stone coming over the orifice 
at the neck of the bladder and closing it. In a few 
moments after the stream will again begin to flow freely, 



446 THE FAMILY PHYSICIAN 

as the stone has rolled away. There is pain now about 
the neck of the bladder. 



The passage of a pebble through the ureter is very- 
painful, and demands prompt treatment. Chloroform is 
now considered to be the proper remedy for this ; it 
relieves by producing relaxation and allowing the peb- 
ble to pass into the bladder. It need not be carried to 
the fullest extent, for partial anaesthesia seems to answer 
every purpose. But if chloroform is not at hand, or 
seems to be contra indicated, a full dose of morphine or 
opium should be given ; if this fail, a cathartic must be 
given — senna and salts will answer for this purpose. 
The spirit vapor bath is indicated here, or a warm hip 
bath, to relax the system as much as possible. 

Diuretics must not be given while the pebble is in the 
ureter, on any account. 

Having reached the bladder, the pebble may after- 
ward, if not too large, be passed by the urethra. For 
this purpose mild diuretics and plenty of slippery elm 
tea or water may be used. 

If the pain or irritation of a fit of the stone, as it is 
called, is very great, the palliative plan of treatment 
becomes necessary : Opiates, the hip bath, and a free 
use of slippery elm water, and an injection into the 
urethra, consisting of morphine, half a grain, and slippery 
elm water, one or two ounces. Alkalines should be used. 

If the stone does not come away in due time, the ope- 
ration of lithotripsy or of lithotomy must be performed. 

The health must be improved by means of diet, exer- 
cise, baths, etc., in order to prevent further accumulations 
of the sand and stone in the bladder. 



AND GUIDE TO HEALTH. 447 



SCURVY— SCORBUTUS 

{GERMAN) SCHAKBOCK. 



These terms take tlieir origin from the Danish Skorbeck, 
" disease of the month," of which the word " Scorbutus " 
is a "barbarous latinized version. 

Scurvy is a peculiar state of mal-nutrition, supervening 
gradually upon the use of a diet deficient in vegetable 
material, and tending to death, after a longer or shorter 
interval, if the same course of diet is persevered in. The 
condition is. essentially marked by a dull, leaden pallor 
of complexion ; excessive bodily debility, and mental 
lethargy ; a spontaneous effusion of blood-colored fluid 
into the various tissues of the body, causing bruise-like 
patches to appear on the surface ; and a livid, spongy, 
swollen state of the gums, and a great disposition for 
them to bleed upon the slightest touch. 

The destruction to human life caused by scurvy in 
olden times, on board of ships and in garrisons located 
under circumstances of difficulty in foreign lands, has 
been most frightful, while it has affected the working 
powers of the survivors in a manner unequaled by any 
other disease. 

It is probable, indeed, from the records which have 
come down to us, that scurvy, either alone or as in- 
fluencing the severity of accompanying maladies, has 
caused more premature destruction to human life than 



448 THE FAMILY PHYSICIAN 

any other disorder. There is no more interesting fact in 
the history of medicine than that this condition which has 
Ibeen looked upon at varions times as a plague, as a mys- 
terious infliction of Divine justice, against which man 
could only strive in vain, or as a disease inseparable 
from long voyages, should have Ibeen proved by evidence 
of the most satisfactory character to arise from causes 
in the power of man to ^prevent, and to be curable by 
means which every habitable country affords. 

Scurvy never occurs when vegetable nutriment is used 
abundantly, even though the other food be inadequate. 

As late as 1854-6 the allied armies of England, France, 
Turkey and Sardinia suffered terribly with this disease. 
In the French army alone 23,000 cases of scurvy was 
reported. 

Dr. Hammond states that during our recent war no 
confirmed scurvy appeared amongst the Federal forces, 
but a scorbutic taint often manifested itself. He attrib- 
uted its occurrence to occasional deficiency in the supply 
of vegetables. In the mountains, in the gold fields of 
America, when the supply of vegetables has been scant, 
much suffering and many deaths have been caused by 
scurvy. It is safe to say that in the States scurvy does 
not prevail as a disease, and this tenderness and spongy 
bleeding of the gums that is so often termed scurvy is 
to be attributed to somnthing else. In all the annals of 
medicine there is not a case on record of scurvy occur- 
ring in any person who has had an adequate supply of 
fresh, succulent vegetables. I make these statements 
that no one need, in a country like ours, where the earth 
is carpeted with green, and the rich verdure of the deep, 
tangled foliage presents an unbroken mass of vegetable 
growth, and where gardens and broad fields almost groan 
under their loads of rich, succulent vegetables, that spring 



AND GUIDE TO HEALTH. 449 

forth in every variety in obedience to nature's laws and 
man's industry — I say, in a country like this, no one ever 
need have the scurvy. 

SYMPTOMS. 

The first symptom observable in scurvy is a change in 
the color of the skin, which becomes pale, sallow, or of 
a greenish tint, according to the variety of natural com- 
plexion. There is a peculiar listlessness of the mind, an 
aversion to exercise, and a condition not so much of 
anxiety as to the state of health as of indisposition to 
take any trouble regarding it. Flying pains are felt 
about the limbs and back, which are generally referred 
to rheumatism. Up to a certain period the appetite 
remains good, and digestion continues tolerably perfect ; 
usually there is some constipation. There is no fever, 
and sleep is obtained readily enough, which is some- 
times described as accompanied by dreams in which the 
luxuries of fruits and vegetables are vividly pictured. 
[See Dr. Kane's U. S. Grinnell Expedition, page 267.] 
Gradually reddish, brown-colored spots are observed on 
the legs and thighs. As the disease advances still larger 
markings are noticed, so much resembling bruises as 
often to be taken for violence. Accompanying these 
external signs there is breathlessness, which the ear 
applied to the chest fails to discover any cause for. The 
expression of the countenance is dejected, or it wears an 
expression of indifference. The lips are pale, and by 
degrees the face assumes a swollen, or rather bloated, 
appearance. There is a sickening, foetid odor from the 
breath. This is only observed as an accompaniment of 
the swollen state of the gums, and is evidently due to 
the sloughing which usually occurs in them. So severe 

is the affection cf the gums in many cases that the fleshy 
29 



450 THE FAMILY PHYSICIAN 

masses are often seen to protrude between the lips. 
Chewing is impossible, and there is some difficulty even 
in taking fluid nourishment. It is impossible to describe 
the fearful appearanee presented by the sufferer under 
these circumstances. His skin is harsh, dry, dirty look- 
ing and discolored, with bruise marks, bloated and 
puffed up in parts by swellings ; his manner apathetic 
and helpless. The condition appears to a novice 
more irremediable than is seen in almost any other dis- 
order. And yet it is remarkable that these cases, strongly 
marked as they are, often yield most readily and surely 
to treatment. The change wrought in a few hours by 
the administration of lemon juice or vegetables, coupled 
with general care, is the most extraordinary thing in 
therapeutics, and of itself furnishes a powerful argument 
in favor of the cause of scurvy existing in the absence of 
such food. 

In confirmed scurvy the slightest pressure suffices to 
open the skin and give rise to an ulcer, whose edges are 
hard, thick and shining, and surface fungoid and bleed- 
ing. Its tendency is to increase rapidly in size and to 
invade the neighboring structures. An intolerable offen- 
sive odor is emitted from it. Ulcers such as these will 
often eat their way into the soft tissues with great rapid- 
ity, exposing and invading large vascular trunks, from 
which dangerous hemorrhage may occur. Sometimes 
the disorganization of the flesh is sufficiently complete 
to expose bones and produce caries. The lips and nos- 
trils are occasionally the seat of this ulceration ; the 
patient then presents a ghastly appearance. The ex- 
haustion attendant upon these spreading ulcers is often 
fatal. 

TREATMENT, 

From what has already been said it seems hardly 



AND GUIDE TO HEALTH. 451 

necessary to tell the reader that the treatment of scurvy 
consists almost entirely in supplying the patient, in the 
most easily assimilable form, with that material by the 
deficiency of which his disorder has been produced. 
" Combined with this," says Dr. Thomas, Buzzard, of 
England, "there will, of course, be needed such a judi- 
cious arrangement of general diet as will most easily 
contribute to his general nutrition. The choice of this 
will much depend upon the condition of the patient's 
gums and digestive organs. It is very important that 
his diet should be varied as much as possible consistent 
with the avoidance of diarrhea. Fresh lemon juice, in the 
form of lemonade, should be administered as the ordinary 
drink ad libitum. The existence of diarrhea should be 
no reason for withholding this treatment. The looseness 
of the bowels in scurvy will be uninfluenced by any 
medical appliance so long as the scorbutic condition of: 
the blood remains uncorrected ; and the fresh juice of the 
lemon has been proved to be more easily digested than, 
any other form of vegetable food." 

Professor Maclean speaks highly of the use of Bael 
fruit in the dysentery which is associated with scurvy. 
The fruit contains a large quantity of tannin with vege- 
table mucous, a bitter principle, and a vegetable acid. 

According to circumstances, the food may consist be- 
sides of good beef tea, with eggs beaten up with wine ; 
or, if the patient can bear it, solid fresh meat, roasted or 
boiled, mashed potatoes, cabbage, milk, salad, or sauei 
kraut. The diet will require careful observation; but 
the great general priciple is to be borne in mind that the 
anti-scorbutic principle must be received by the patient 
in one form or other, if his treatment is to. be successful.. 

When diarrhea is persistent, the trisnitrate^of bismuth; 
with opium may often be given with great advantage 



452 THE FAMILY PHYSICIAN 

the use of fresh lemon juice being, however, continued at 
the same time. When the gums slough and bleed very 
much they should be brushed over daily with solid 
nitrate of silver. An amount of relief is thus afforded 
which it is difficult to explain. 

For the offensive fceter of the breath a solution of 
chlorate of potash — twenty grains to the ounce of water — 
may be used to rinse the mouth. 

Fot the hard swellings in the hams and legs, friction 
with warm soap suds and water several times a day may 
be employed to great advantage. Scorbutic ulcers may 
be dressed with lint soaked in lime juice and covered 
with oiled silk. But all local remedies are but palliatives, 
and are inert as substitutes for the constitutional treat- 
ment of the disorder. 

Among the list of vegetables which may be used as pre- 
ventives of scurvy are oranges, lemons, limes, cabbage, 
lettuce, potatoes, onions, mustard and cress, dandelion, 
sorrel, scurvy-grass, the agave Americana (cactus), sauer 
kraut and grapes. An ounce of lemon juice should be 
issued daily when vegetables xun short ; and on ship- 
board should be begun not later than ten days after the 
deprivation of vegetables. 

There has been a very ingenious form of preserved 
vegetables prepared by MM. Masson & Chollet, of Paris. 
It consists of cauliflower, carrot, lettuce, peas, &c, dried 
and compressed into solid slabs, which are very portable 
and will keep good for any length of time. The prepara- 
tion requires soaking for four or five hours in water 
before use, and then should be cooked very slowly. 

" In the Confederate army," Dr. Darby says, u the yam 
which is generally cultivated throughout the South was 
found very beneficial. Syrup from the Chinese sugar- 
cane (sorghum), abundantly manufactured during the 



AND GUIDE TO HEALTH. 453 

last two years of the war, was issued as a ration with 
decided benefit. When badly made it is liable to fer- 
mentation, and deranges the bowels, yet even in this con- 
dition it was of great service in scorbutic cases, as was 
also the extracted juice before it was boiled." 



CATARRH, OR COLD-INFLUENZA 



Catarrh consists of acute inflammation of the mucous 
membrane of some of the air passages. 

Influenza, when mild, is termed cold, but I think not 
properly. 

It is an epidemic disorder, attended with great depres- 
sion, chilliness, running from the eyes and nose, frontal 
headache, cough, restlessness and fever. 

" Influenza arises," says Tanner, " at various periods 
from some peculiar condition or contamination of the 
atmosphere. The first visitation of it in this country 
(England) of which we have a trustworthy description 
is that of 1510. The poisonous influence, whatever its 
nature may be, wings its way with greater celerity than 
the speed of human intercourse, while its progress seems 
uninfluenced by the seasons of the year ; it is said to 
travel from east to west, and it seldom stays in one 
district more than six or seven weeks. Some visitations 
have proved more severe than others ; one in 1782, which 
extended over the whole of Europe, was very fatal." 
Dr. Southward Smith says, " That when the influenza 
broke out in London, in 1847, it spread in a single day 



454 THE FAMILY PHYSICIAN 

over every part of the metropolis, and affected upward 
of 500,000 persons." 

SYMPTOMS. 

The chief symptoms of this mysterious affection are, 
heat and dryness of skin, urgent frontal headache, cryza, 
sneezing, tenderness of the fances, hoarseness, harassing 
cough, shortness of breath, pain in the "back and limbs, 
perverted taste, disorder of the stomach, together with 
all the signs of nervous and muscular prostration, such 
as an uncommon degree of languor, debility, and 
dejection of spirit. Occasionally the danger is much 
increased by the setting in of acute bronchitis, or even 
of inflammation of the lungs. 

Influenza differs from a common cold in its greater 
severity, and especially the amount of prostration which 
it gives rise to. 

TREATMENT. 

The vapor bath (spirit), or a warm bath, should be 
taken, and the patient comfortably put to bed with a hot 
brick or jug of hot water put to his feet ; ten grains of 
Dover's powder should then be administered, and, in 
eight or ten hours, a saline cathartic. 

If prostration be a symptom, a nourishing diet must be 
allowed, with an occasional " hot brandy toddy." It 
may become necessary to administer tonics, in which 
case quinine, tincture of barks or tincture of iron will 
answer. It may become necessary to repeat the Dover's 
powder occasionally. 

Catarrh is a disease the most common to which the 
human family is obnoxious. It arises not from mere 
cold, but from too sudden a change of temperature, or 
from exposure to wet ; or sometimes when we are totally 



AND GUIDE TO HEALTH. 455 

unable to recognize any particular cause. Dr. Hyde 
Sutter has suggested that the symptoms of catarrh depend 
upon a specific animal poison ; and that they are attrib- 
utable either to the material presence of this poison 
circulating in the blood, or to the irritation which it 
produces in those organs which are its constituted 
elements. The arrest of the functions of the skin from 
exposure to cold throws back into the circulation that 
which ought to have been eliminated as the cutaneous 
excretion ; and this, either by itself or by ulterior 
changes which it gives rise to in the blood, induces a 
condition of blood poisoning — toxcemia. So long as the 
blood is thus contaminated the fever symptoms persist, 
while its depuration is immediately attended by their 
abatement. 

TREATMENT. 

Every one knows, in his own estimation, just how to 
treat a cold ; he has a specific that he has tried and 
proved a dozen times on himself and others. Some will 
deplete, some will stimulate, some will feed high, while 
others will starve ; some will take cold draughts, and 
some will take hot ones, while all are confident that they 
are right. Now, the solution to the whole affair is, while 
they are amusing themselves with slops, pills, and a lot 
of patent drugs that they know no more about than 
they do about the inhabitants of the moon, the cold gets 
well — has run its course — and they think they have found 
a specific in the last article they used, and are ready to 
give the quack who made the compound a certificate 
setting forth the merits of his pernicious drug. 

An attack of cold can be cut short by the administra- 
tion of a saline cathartic, and as soon as it has operated 
give a ten-grain dose of Dover's powder, and repeat it 



456 THE FAMILY PHYSICIAN 

two or three times in the course of the twenty-four 
hours. In severe cases the spirit vapor Ibath may "be 
used ; the diet may "be good and free, with a hot Ibrandy 
or good whisky toddy at "bedtime. Prophylactic treat- 
ment is better than the remedial, for it is always better 
to prevent a disease than it would be to cure. One of 
the surest preventives of cold that I could recommend, 
and at the same time a preventive of many other dis- 
eases, particularly of the skin, is a cold bath at night, 
either by a plunge into the bath tub or by a free sponge 
bath or a shower bath ; if the latter is used, however, the 
water should not be too cold. This, with ordinary care, 
and a proper attention to clothing, will generally protect 
you from colds. 

Cold, considered in the abstract, is not a serious thing 
by any means ; but when we sum up the long catalogue 
of diseases that it may cause, and does unquestionably 
cause, we might well be struck with terror at its approach. 
If I was compelled to list the diseases caused by and 
growing out of colds I would attempt to do it by men- 
tioning the exceptions, and believe I could do this with 
a shorter list than to mention the number it may cause. 
Hence it does not require a very clear perception to see 
the necessity of avoiding colds as much as possible. 
Then keep your feet dry and warm, your body and 
limbs warmly clothed in winter with suitable clothing ; 
keep the head cool, and avoid as much as possible all 
transitions from hot to cold, never allowing yourself to 
be exposed to a current of cold air when you are in a 
free perspiration. Avoid as much as possible the night 
air, unless you have on extra clothing ; but do not forget 
a cold bath of some description ; do not take it in the 
morning, as some do, before the circulation has recov- 



AND GUIDE TO HEALTH. 457 

ered from its sluggishness consequent npon sleep, "but 
take it just before retiring at night ; it will soon get to 
be a luxury and amply repay you for the trouble. 



HYDROPHOBIA. 

CANINE MADNESS— RABIES 



Dr. Tanner, in his excellent Practice of Medicine, says: 
" Of the diseases which may arise from inoculation with 
poisons generated by unhealthy animals, hydrophobia 
{rabies) is the most distressing. It is, indeed, a fearful 
malady, not only on account of its almost universal 
fatality, but also because of the great suffering it gives 
rise to. Rabies is said to occur spontaneously in the 
canine, and perhaps in feline races ; but it is communi- 
cated by inoculation with the saliva to other animals and 
to man." 

SYMPTOMS. 

The pathognomonic signs are — cramps of the muscles 
of the pharynx and thorax, spasmodic action of the dia- 
phragm, a great dread of fluids, difficulty in drinking, 
restlessness and anxiety, delirium, exhaustion and death. 

A person, we will suppose, is bitten by a rabid animal. 
After an uncertain interval, called the stage of incuba- 
tion, or the latent period, he begins to complain of men- 
tal uneasiness, chilliness, langour and lassitude ; there 
is restlessness also, loss of appetite, and more or less 
headache. Sometimes a sensation of numbness, or even 



458 THE FAMILY PHYSICIAN 

of great soreness in the bitten part, is experienced ; but 
in any case the precursory symptoms are followed, in 
two or three days, by the confirmed stage of the disease. 
This commences generally with garrulity, peculiar sigh- 
ings, nausea and fever, to which succeeds stiffness of the 
neck, difficulty of breathing and swallowing, a horror of 
liquids, an alarming sense of suffocation, and an excessive 
secretion of saliva, causing frequent hawking and spit- 
ting. There now set in violent spasmodic convulsions 
of the whole body, the paroxysms being occasioned 
especially by the sight of liquids, or the sound of 
running water, or any attempt at drinking. The spas- 
modic terror inspired by the sight of water has been well 
described by Dr. Marcet, who, in relating the history of 
a case of hydrophobia, says : " On our proposing to him 
to drink he started up and recovered his breath by deep 
convulsive inspiration; yet he expressed much regret 
that he could not drink, as he conceived that the water 
would give him great relief, his mouth being evidently 
parched and clammy. On his being urged to try, how- 
ever, he took up a cup of water in one hand and a tea- 
spoon in the other. The thought of drinking out of the cup 
appeared to him intolerable, but he seemed determined 
to drink with a spoon. "With an expression of terror, 
yet with great resolution, he filled the spoon and pro- 
ceeded to carry it to his lips, but before it reached his 
mouth his courage forsook him, and he was obliged to 
desist. He repeatedly renewed the attempt, but with no 
better success. His arm became rigid and immovable 
whenever he tried to raise it toward his mouth, and he 
struggled in vain against this spasmodic resistance. At 
last, shutting his eyes, and with a kind of convulsive 
effort, he suddenly threw into his mouth a few drops of 
the fluid, which he actually swallowed ; but at the same 



AND GUIDE TO HEALTH. 459 

instant lie jumped up from his chair and flew to the end 
of the room, panting for breath, and in a state of inde- 
scribable terror." 

About the second day the symptoms become more 
severe. The thirst gets distressing ; there is pain at the 
epigastrium, and flatulence ; the countenance is anxious 
and indicative of despair; the forehead is, perhaps, 
covered with cold, clammy sweat ;. and there is, generally, 
much mental distress, though the intellect remains per- 
fect. As the fatal issue quickly approaches the sense 
of suffocation becomes more urgent ; the surface of the 
body is so sensitive that a draught of cold air, or the 
lightest touch, brings on convulsive paroxysms ; the 
senses of hearing and vision get morbidly acute; the 
saliva is more difficult to expel, though the attempts at 
spitting are incessant; there is frequent micturition, 
until at length the terror becomes succeeded by wild 
delirium, which ends in exhaustion and death. 

The stage of incubation in hydrophobia may be said 
to vary from forty days to eighteen months. Cases have 
been known where the symptoms set in as early as the 
eighth day, while others have gone four years. 

The disease only lasts a few days — say from two to 
six — counting from the commencement of the confirmed 
stage. Only a small number who are bitten by rabid 
animals have hydrophobia. 

TKEATMENT. 

This must be prophylactic, for the cure of the disease 
seems, in the present state of medical knowledge, almost 
hopeless. The wounded part is to be excised as soon as 
possible after the bite, care being taken to remove every 
portion touched by the animal's teeth, and to obtain a 
clean raw surface. The wound is then to be thoroughly 



460 THE FAMILY PHYSICIAN 

washed by a stream of water long poured over it, and 
lunar caustic afterward applied. Mr. Youatt prefers the 
nitrate of silver freely used to every other caustic ; and 
he also recommends that, after its application, the wound 
should he quickly healed, though many authors advise 
that it should be kept open "by irritating ointments. 

In treating the disease itself, I should resort to the in- 
halation of chloroform, the use of opium, Prussic acid, 
Indian hemp and ice, though without much hope of 
success. 



STIIG OF INSECTS. 

POISONED WOUNDS. 



The stings of insects produce a poisoned wound of the 
simplest class, the wound being a mere puncture, and 
the irritation created by the poison not very violent. 
They generally give rise to no constitutional symptoms, 
unless the number of the bites or punctures are very 
great, as in the case of bees, which, when swarming, 
have been known to cause the death of the person stung. 

In the bite of the mosquito or bed-bug there is a slight 
amount of irritation produced by the saliva of the insect, 
which is effused into the wound during the process of 
mastication, the wound being made in the act of feeding. 

Diagnosis. — A careful examination of the wound in- 
flicted by the sting of bees, wasps, hornets, etc., will 
generally exhibit the sting of the insect imbedded in the 
wound, which, with the history in severe cases, will ren- 
der the diagnosis easy. 



AND GUIDE TO HEALTH. 461 

Prognosis. — In numerous injuries by bees or wasps, 
and especially in those within the month and throat, or 
in the eye, the sting may create snch irritation as will 
be very tronblesome. They shonld not, therefore, be too 
lightly spoken of, thongh seldom fatal except in attacks 
from swarms. 

TEEATMENT. 

The salivary matter injected or allowed to flow into 
the wonnd after puncture by an insect, as a spider or 
bug, being generally acrid or acid in its character, the 
external application of alkalies, as aqua ammonia, liquor 
potassse, salt and water, with subsequent applications of 
the cold water dressing, nearly always suffice to remove 
the irritation. 

The sting of the bee or wasp presents also the same 
general facts, though in these insects there is a wound 
made as the result of an attack, the puncture and the 
introduction of certain acrid irritating matters secreted 
by a gland, and contained in a little sac at the base of 
the sting, being resorted to as a means of offense and 
defense. The wound made by the sting of the bee, wasp 
or hornet is usually very small, but is soon surrounded 
by a certain amount of inflammation, which is indicated 
by more or less redness. Dain. heat and swelling, the 
latter being generally of an cedematous character. When 
the sting remains in the wound it may be recognized as 
a fine, black point, as a needle. As it would prove a 
source of irritation if allowed to remain, it is necessary 
to withdraw it ; this may be done by seizing it cau- 
tiously with fine forceps, after which the application of 
the various alkalies will prove useful, by neutralizing, 
more or less, the poison introduced. 

A popular remedy amongst the common people, and a 



462 THE FAMILY PHYSICIAN 

good one, too, is the strong juice or a poultice of tolbacco. 
The tobacco chewer is stung by an insect ; he " squirts " 
the juice from between his teeth on the injured part and 
smears it well over it, or takes the quid from his mouth 
and binds it on it, and "goes on his way rejoicing," 
wholly unconscious in a few minutes that any accident 
has happened him. 

When the stings of wasps, hornets, yellow jackets or 
bees are very numerous, the multiplication of irritation 
will sometimes produce constitutional disturbance, the 
amount of injury necessary for this purpose being much 
less in persons of intemperate than those who are of tem- 
perate habits. Indeed, in persons whose blood has become 
depraved by intemperance the most trifling injuries will 
sometimes prove fatal ; thus j/there are cases on record 
where the individual has died from the bite of the com- 
mon spider.. 

There is one case, however, in which the sting of a 
single bee or wasp may prove seriously injurious — 
that is, when.it is inflicted in the fauces, as may happen 
when the insect is taken into the mouth in a piece of 
honey comb, the swelling of the fauces rapidly proving 
fatal by creating oedema of the glottis, and preventing 
the entrance of air into the trachea. In such case 
cooling or detergent gargles would be the proper class of 
local applications ; or scarifications of the glottis, or 
tracheotomy might become requisite if positive strangu- 
lation cedema of the glottis supervened. 



AND GUIDE TO HEALTH. 463 



SNAKE BITES. 



There is a large number of serpents capable of causing 
serious danger to life by their bite. It is not necessary, 
however, to enter into all the details of these ; the cobra 
di capello and other Asiatic snakes, of course, are not 
met with here. 

The copperhead and other venomous snakes of the 
United States cause by their bite a series of symptoms 
which are embraced with but little variation in the fol- 
lowing details of the bite of the rattlesnake. 

The rattlesnake, it is said, seldom bites man, except in 
self defense, and generally gives warning of his presence 
by means of the little apparatus in his tail, from which 
he derives his name. In making the wound the poison 
is introduced through a puncture made by a long, sharp 
tooth in the upper jaw, corresponding in position with 
the canine tooth in the dog. 

This tooth is not firmly attached to the jaw, but is 
movable, being acted upon by certain muscles. It is also 
hollow, and contains at its base a little sac, which com- 
municates by means of a duct with the poison gland. 
When the snake strikes it raises itself in a coil, throws 
its head back, and then strikes downward, the tooth 
making a wound from above downward ; the contraction 
of the muscles in erecting the tooth acting upon the sac 
at its base, and the poison being forced out by the side 
of the tooth into the wound. 



464 THE FAMILY PHYSICIAN 

The poison thus introduced may prove rapidly fatal, 
particularly if the wound has Ibeen made directly upon 
the skin, and not through the clothing. Death follows 
most rapidly if a small vein or artery is punctured 
(occurring in certain of the lower animals in as short a 
time as nine minutes), but when the poison is simply in- 
troduced into the areolar tissue of the parts the symp- 
toms are less imminent, and are as follows : 

SYMPTOMS. 

Shortly after the puncture of the bite a pain of a 
burning, tingling character is felt, which is particularly 
violent, and sometimes creates a brief spasm, if one of 
the cutaneous nerves has been wounded. The part then 
swells rapidly — an arm that has been bitten becoming 
double its ordinary size three or four hours after the 
injury. 

The general symptoms which are developed at various 
periods after the injury are those of depression, which 
sometimes come on very rapidly, the patient dropping 
suddenly, as if struck dead. Sometimes, and most com- 
monly, the progress of the case is more deliberate ; 
there are nausea, vomiting, high febrile action, delirium, 
sense of constriction in various parts of the body, 
typhoid symptoms, and death, preceded by coma or by 
convulsions. 

TKEATMENT. 

The indications for the treatment of bites of serpents 
are two : first, to check or prevent the absorption of the 
virus ; second, to prevent the depression from proceeding 
to such a point as to prove fatal. 

These indications are to be fulfilled by both local and 
general measures. 



AND GUIDE TO HEALTH. 465 

Tlie means to be employed in fulfilling the first indi- 
cation are such as attempt the removal of the poison. 

If the patient be in the woods at the time of the acci- 
dent, and without other means, he may, without hesita- 
tion, suck the wound, with a view of extracting the 
poison, for it has been fonnd that when applied to mu- 
cuous surfaces, npon which no abrasion exists, the poison 
is innoxious. If the wound is situated where it would 
be possible to cut it ont without danger it should be 
done immediately after the bite. By this means the poison 
may be removed before it can be taken into the circula- 
tion ; if the poison is not all removed by this means the 
hemorrhage provoked may wash ont the noxious matter. 

Dr. Peake, of Mississippi, has reported a case (in the 
JVew Orleans Medical Journal) of rattlesnake bite, in 
which the patient chewed and swallowed promptly two 
ounces of tobacco, which did not even nanseate him. 
The limb swelled very little, and the next day the pa- 
tient was about and well. I have heard also of another 
case occurring in one of the counties of Southwest Mis- 
souri, where a man was bitten by a rattlesnake. Being 
alone and at a considerable distance from any settlement 
where it wonld be likely that he could get assistance, he 
looked abont him in considerable alarm for something 
or other that he might take ; certain death seemed to stare 
him in the face. As he felt the burning, tingling pain the 
nnwelcome thonght more than once flitted across his 
brain, how terrible it wonld be to die here so suddenly 
and all alone. In his mechanical search, in one of his 
pockets he found a plug of tobacco, and in his despera- 
tion and despair he chewed and swallowed it, juice, sub- 
stance and all, and, to his infinite delight, he felt the 
burning, tingling pain cease, and the limb which had 

already begun to swell ceased to enlarge ; he was 
30 



466 THE FAMILY PHYSICIAN 

enabled to proceed on his journey, and was well in a 
few days. 

Under circumstances in which the alcoholic treatment 
can not he had at once, I would earnestly recommend the 
chewing and swallowing of at least two ounces of tobacco. 
It has been recommended to wash the wound with liquor 
of ammonia or liquor of potassa. 

In regard to the alcoholic treatment of these snake 
wounds, there is a popular idea that if a person bitten 
by a rattlesnake is able to get drunk he will not die. It 
is, therefore, by no means uncommon for persons when 
thus bitten to procure a quart of whisky and drink to 
extreme intoxication. The evidence in relation to the 
relief given by the free use of whisky or brandy, judi- 
ciously administered, is so strong that few, I think, 
would be justified in not resorting to it. 

Surgeon Gr. E. Cooper, of the United States Army, re- 
ports five cases that came under his and surgeon Getty's 
care while in Western Texas, all of which were success- 
fully treated with whisky or brandy. The liquor was 
given at first in tumblerful doses, and continued in half 
tumblerfuls until the patient fell perfectly drunk ; and 
when the effect of the alcohol was passing off, he was 
made to drink as long as any whisky would remain on 
his stomach. Cold water dressing was applied to the 
wound, and this was all the treatment used. 

Dr. Cooper adds : " It was really gratifying to observe 
the effects of the remedy. ~No sooner had the patient 
fallen under the effects of the alcohol than the wounded 
part, which till then had continued to swell, immediately 
began to cease swelling, and the muscular jerking — a 
source of great pain to the sufferer — ceased, and from 
that moment convalescence began. It seems almost in- 
credible when the amount of liquor required to intoxicate 



AND GUIDE TO HEALTH. 467 

a "bitten person is told. In one case it required a bottle 
of brandy and a bottle and a half of whisky before any 
observable effect was produced. In another two bottles 
of proof Bourbon whisky were used. As soon as the 
effects of the alcohol were observed a greenish fluid 
commenced to ooze from the wound. As the oozing com- 
menced the swelling of the part diminished. In fine, I 
know of no better remedy, nor do I want a more certain 
one ; but it must be used in time, ere the whole integu- 
ments covering the bitten limb have become discolored, 
and the poison produces too much change in the blood 
and causes such prostration of the nervous system as to, 
render reaction impossible." 

This remedy has long been known and used by the> 
hunters of the Rocky Mountains. 

The bite of the tarantula, though often referred to with- 
a certain amount of superstition and poetic license as, 
causing the ecstasy or dancing epidemic in the fourteenth 
century, exhibiting many disgraceful scenes in Europej 
occasionally is seen to induce evidences of depression 
differing entirely from the dancing emotions ascribed to 
it by the people in Italy. 

In a case reported by Dr. Heurd, of Texas, in the New 
Orleans Medical Journal, vol. xvi, p. 784, 1859, a patient, 
aged twenty, in good health, was bitten on his right 
hand. No swelling or other evidence of inflammation 
ensued, but the patient was depressed, with shivering, 
cold, clammy skin, and sunken countenance. After ad- 
ministering morphia, ether, carbonate of ammonia, 
spirits of ammonia and camphor, without effect, he was 
bled and obtained complete relief. 

The secret of the complete relief obtained lies in the 
effects produced by the stimulants — the ammonia and 
camphor — which had to overcome the depression pro- 



468 THE FAMILY PHYSICIAN 

duced by the wound, and the further lowering of the 
system by bleeding. 

The proper treatment for the bite of the tarantula is 
alcoholic stimulants, used freely, in connection with a 
tobacco poultice to the wound. The tobacco poultice is 
also a valuable auxiliary in the treatment of snake bites. 



BUEIS. 



Burns are changes of vital action created by the appli- 
cation of an unnatural degree of heat. There are two 
modes in which they may be produced — one by the 
application of hot solids, the other by hot liquids. The 
first are strictly classed as bums, the latter as scalds. 

TREATMENT. 

The treatment of burns must, of course, vary with the 
injury. In light, superficial burns, nothing more is 
necessary than the free application of cold water or ice. 
Nothing is more natural after burning -a finger than to 
put it into cold water with a view of allaying the pain, 
and as both cold and moisture have a sedative effect, no 
better plan of treatment can be pursued. 

If the burn is situated on a part so that it may be 
submerged in a vessel of water, no better treatment can 
be recommended than to submerge it and allow it to 
remain for several minutes, and when it is taken out let 
it be penciled freely with a mixture of equal parts of 
linseed oil and lime water ; this application should be 



AND GUIDE TO HEALTH. 469 

frequently repeated, so as to give the parts protection 
from the atmosphere ; and when the pain is severe apply 
the water again. 

But if the burn is not situated so that it can be sub- 
merged in a vessel of water, cold may be applied by 
means of a bladder of pounded ice, or partly filled with 
cold water, or by pouring on cold water ; the bladder 
should not be filled too full of ice so as to be too heavy 
on the affected part. 

In the case of burns where there are blisters and a raw 
surface exposed, it may be necessary to resort to raw 
cotton, carded and laid on the part, well saturated with 
the " carron oil," which is the linseed oil and lime water 
above mentioned. One object must always be kept in 
view, i. e., the protection of the parts from the atmos- 
pheric air. 

In the superficial burns resulting from the accidental 
explosion of gunpowder, grains of powder unconsumed 
are often buried in the skin, and leave subsequently a 
blue point, which disfigures. These may be removed by 
the application of a solution of corrosive sublimate, live 
grains to the ounce ; this will produce an eruption, the 
vesicle of which will contain the grain of powder, which 
will fall off with the dried scales resulting from the 
vesicle. 

In the more severe forms of burns, where there is a 
disposition toward sloughing, as it is always desirable 
to favor the early separation of the slough, there is noth- 
ing better than the warm water dressing, applied from 
the very first moment, and continued throughout the 
treatment as long as heat and moisture can be beneficial. 
One great recommendation of this dressing is its cleanli- 
ness, the constant flow of water washing away the 
pus before it can be decomposed, thus securing the 



470 THE FAMILY PHYSICIAN 

purity of the air of the chamber and removing one great 
source of annoyance in these accidents. The old plan of 
burying the patient in poultices is objectionable, because 
they are heavy, liable to become varied, to interfere with 
cleanliness, to adhere to the diseased surface, and to act 
as receptacles for the very free discharge of pus which 
generally ensues upon a burn, and which soon becomes 
offensive from its decomposition. Patent lint, well wet 
with warm water, as in the warm water dressing already 
described, gives moisture and heat in a much neater 
form, and does not oppress the patient. As soon as the 
slough seems disposed to separate, it will be useful to 
stimulate the action of the parts so as to favor the cica- 
trization, evidences of a want of action being generally 
present in the granulations of an ulcer which remains 
after a burn. A good application for this purpose is 
basilicon ointment, to which a little turpentine has been 
added : ten drops of spirits turpentine to the ounce of 
basilicon ointment, well stirred and mixed. "A very 
important part of the treatment of burns is the manage- 
ment of the ulcer which is left after the separation of the 
eschar or slough. This is frequently very difficult to 
heal, and presents the characters of the ordinary irritable 
ulcer. In order to favor its cicatrization sedatives will 
often prove useful, such as the cold water dressing, 
which is very soothing, and by washing away the pus 
from suppurating burns is kept off one source of irrita- 
tion. Sometimes, in the ulcerated stage of burns, stim- 
ulating applications are demanded in order to excite 
reparative efforts and overcome the local depression 
consequent on the injury— such as touching the edge of 
the ulcer with a stick of nitrate of silver, stimulating the 
parts and inviting the scabbing process by dusting the 
surface of the ulcer with finely pulverized calamina or 



AND GUIDE TO HEALTH. 471 

prepared chalk, and then covering it with a piece 
of spread cerate and oiled silk, so as to exclude the 
air." — Smith. 

The cicatrices produced by burns are almost always 
very considerable, often making great deformity. This 
seems to be wholly unavoidable ; the only thing we can 
do is to watch and prevent adhesions, such as the fingers 
and toes, and particularly the orifices, such as the 
mouth, nose, the anus, or the vagina, etc., etc. The 
depression produced on the general system by burns 
must be met by stimulus, and later by good diet, etc. 



GANGRENE. MORTIFICATION. 



By the term mortification is understood the loss of 
the vital function of a part, or the destruction of its 
organic texture, either from the action of some direct 
cause, as heat, cold, &c, or from the application of such 
means as produce immediate disorganization of the 
tissues, or from the effects of indirect causes, as the 
degeneration and destruction which ensue when tissues 
are deprived of that which is essential to their nutrition. 
By surgical writers two distinct conditions of parts are 
recognized under the general term of mortification — one 
in which the superficial tissues are mainly involved, 
being named gangrene ; while that which also involves 
the deep-seated parts, and thus induces the entire death 
of the part, is called spliacelus. The term mortification 
should, therefore, be regarded as the generic expression, 



472 THE FAMILY PHYSICIAN 

characterizing in a general way the death of structure ; 
while gangrene and sphacelus indicate the specific 
extent or degree to which it extends. In gangrene there 
is usually noted the death of the skin, fascia and mus- 
cles; while the additional death of the blood-vessels, 
nerves, tendons, ligaments and bones constitutes spha- 
celus. 

The dead portion resulting from a circumscribed gan- 
grene is usually spoken of as a " slough ;" while the 
process which results in it is designated as " sloughing." 

SYMPTOMS. 

In the local sjmrptoms of mortification, as well as in 
those of inflammation, there may be noted change of 
color, heat and sensation in the part, together with a 
modification of secretory action in it as well as in the 
organs of the general system. 

When mortification has commenced, the color of the 
inflammation which generally precedes it is changed 
from the red of acute, and the more purple tint of 
chronic inflammation, to a hue which is of a darker 
character, being first brown and then black. 

The temperature, also, either rises to that of the 
highest grade of inflammation, or else, as is more usual, 
falls much below the natural standard, until ultimately it 
reaches the cold of death. The natural sensation of the 
part is also much modified on the occurrence of mortifi- 
cation, being sometimes very much increased, and at 
others diminished, until, as in death, the part becomes 
entirely devoid of sensibility. 

The effusions or products resulting from mortification 
are also of a peculiar character, differing materially from 
those seen in ordinary inflammation or inflammatory 
action ; the formation of lymph or of pus, so constantly 



AND GUIDE TO HEALTH. 473 

seen in the different degrees of inflammation, being 
entirely absent in the mortified strnctnre, though it may 
be present in the adjacent parts when nature is endeav- 
oring to check the progress of the disorder. The forma- 
tion of serum in mortification is, however, greater than 
that which accompanies healthy inflammations. 

The general symptoms which present themselves in 
cases of mortification may be described in almost one 
word as those of depression. There is generally a quick, 
irritable pulse, not unlike that of some of the low grades 
of fever. The digestive apparatus is also disordered, 
the tongue furred, and loss of appetite, with other evi- 
dences of a typhoid disorder, such as diarrhea, colliqua- 
tive sweat, cold skin, &c. As the typhoid symptoms are 
developed the disorder of the nervous system becomes 
highly marked, and is shown in the anxiety of counten- 
ance, restlessness, insomnia, hiccough, 'floccilation, stu- 
por and death. 

Mortification may be either acute or chronic, humid 
(moist), or what is designated " dry gangrene." 

TKEATMENT. 

This must consist in thoroughly supporting the patient 
by the use of stimulants and tonics. For this purpose 
the tincture of Peruvian bark or quinine must be freely 
given, in connection with good Port or Sherry wine, and 
a diet of beef tea. The parts may be washed with a 
weak solution of sulphate of zinc, and painted around 
the edges on the healthy skin with tincture of iodine. 
It has been recommended to place a strip of blister 
around the limb above the mortified part to prevent its 
extension. I would not like, however, to recommend a 
course of this kind. A poultice, warm, composed of 
flax-seed meal and finely powdered charcoal, may be 



474 THE FAMILY PHYSICIAN 

placed upon the affected part and changed often. The 
greatest dependence is to Toe placed in the proper sup- 
port of the system, as the prominent symptom of depres- 
sion would readily indicate. 

After the part has become dead, and there is a " line 
of demarcation," it must be removed ; a surgical opera- 
tion will sometimes be necessary for this. If the liquid 
effusion take place to such an extent as to threaten to 
do mischief, either by being absorbed or by burrowing 
into the adjacent cellular tissue, several free incisions 
should be made through the skin and cellular tissue, in 
order to facilitate the evacuation of the fluids; those 
which escape being absorbed by bran or other dry powder 
and removed at the subsequent dressing. Opium is 
often of great service in the treatment of this disorder, 
as it acts in two ways : first, by allaying pain and check- 
ing the nervous irritation, thus diminishing the inflam- 
matory action ; and second, by checking all other secre- 
tions, and yet acting on the skin so as to induce perspi- 
ration. The quantity of this must be governed by the 
circumstances. One grain being an ordinary dose for 
an adult. 



AND GUIDE TO HEALTH. 475 



FROST BITE. 



This presents, in a modified form, all the symptoms 
of marked inflammatory action and perversion of the 
local nutrition in the part affected which have "been 
detailed in connection with inflammation, under the head 
of gangrene. Frost bite is, in truth, a term only expres- 
sive of the fact, as recognized by the ancients, that the 
gangrenous condition has been induced by cold. 

TKEATMENT. 

With regard to the indications in the treatment of 
frost bite, it is a repetition of the principles laid down 
when treating of mortification, that is, to favor the forma- 
tion of the line of separation and ulceration that the 
dead parts may be thrown off, while we afterward promote 
the processes of granulation and cicatrization that the 
ulcers may be made to heal, a result which it is sometimes 
difficult to obtain, owing to their unhealthy and irritable 
character. Until reaction supervenes the treatment of frost 
bite should be stimulating, or by applications of spirits of 
camphor, &c. ; but after reaction takes place the warm 
water dressing and solution of sulphate of zinc may be 
used. Persons who have had their feet frozen while walk- 
ing in the cold snow with thin boots have avoided all the 
disagreeable effects by walking into a spring of living 
water and standing for several minutes, and then removing 
their boots and having their feet well rubbed dry with a 
coarse towel. 



476 THE FAMILY PHYSICIAN 



ULCERATION AND ULCERS. 



A degeneration of the products of inflammation and of 
the tissues affected by it rapidly follows when the inflam- 
matory action is of a certain degree of intensity. This 
degeneration or loss of vitality Ibeing most apt to result 
in a sore or ulcer, the process which forms it is designated 
as " ulceration ;" and as this process develops an "ulcer," 
ulcerations and ulcers are not only naturally associated 
with each other, but are sometimes loosely described as 
identical. There is, however, this difference: that an 
ulcer can not be formed until the process of ulceration 
has previously existed — the one (ulceration) being the 
cause the other (the ulcer) the effect. 

ULCERATION. 

The term ulceration is employed to express that vital 
action by which a solution of continuity is created in any 
structures of the body, but especially in those known as 
the soft tissues. Ulceration is established as follows : 
Inflammatory action being developed is followed by con- 
gestion of the vessels of the part, and this congestion, 
by impairing the supply of blood, impairs the nutrition 
of the cells. "When the inflammatory action goes as far 
as suppuration, and the vitality of the structure is so 
much diminished that the cells die and are removed faster 
than they are reproduced by the organization of the lymph 



AND GUIDE TO HEALTH- 477 

that is effused, a deficiency of structure results, to which 
the name of ulcer has been applied, while the process is 
called ulcer at ion. In the development of ulceration the 
lymph or exudation corpuscles which had previously 
been effused degenerate from two causes— first, from an 
imperfect circulation in the part affected, and secondly, 
from the fact that they are softened or disintegrated by 
contact with the pus already formed, thus creating a 
semi-fluid mass that gives evidence of fatty degenerations 
and the liquefaction or moistening and breaking down 
of tissue cells that characterize it. It is, therefore, easily 
perceived that the process of ulceration under this view 
of the subject can never take place in a healthy tissue, 
and that the parts must first be diseased or inflamed to 
a greater or less extent before ulceration is established. 
The old idea that an ulcer was formed by the corroding 
action of the pus is erroneous, the pus of a healthy ulcer 
being perfectly bland. The spreading of the ulcer is due 
to a continuation in the surrounding tissue of the process 
oy which it was originally formed. This is a fact which 
it will be well for the practitioner to remember in the 
treatment of ulcers, so that he will not fail to properly 
brace the system against danger, remembering that ulcer- 
ation, when once established, is extended, first, by the 
molecular death of the tissue immediately surrounding 
the primary ulceration, and secondly, by the detachment 
and casting off of the cells thus destroyed, their removal 
being favored by the pus which accompanies the ulcera- 
tive action. An examination of any rapidly spreading . 
or sloughing ulcer, when the structure is destroyed faster 
than it can be removed, will readily show this process, 
the dead matter which there accumulates being left 
directly before the eye of the observer as a mass which 
has been specially designated as a " slough." Of the 



478 THE FAMILY PHYSICIAN 

soft tissues, the skin and areolar tissue are the most 
liable to ulceration, the tendons, ligaments, Mood vessels 
and nerves resisting this destructive action in a marked 
degree. 

ULCEUS. 

The chasm in the tissue created by the ulcerative pro- 
cess constitutes the condition designated as an ulcer or 
sore. 

Chaussier defines an ulcer to Ibe " a solution of con- 
tinuity in any of the soft or hard tissues, produced by a 
general or local cause, and accompanied by a discharge 
of pus, ichor, or sanies." 

Prof. Henry H. Smith, of Philadelphia, says : " Now, 
as the process of ulceration exhibits any one stage in the 
progress of inflammation, and as granulation and cica- 
trization also constitute portions of the grand process by 
which nature repairs all solutions of continuity, a much 
more simple classification of ulcers" (he says this in 
respect to the classification of ulcers by other writers, 
which are very complicated) "would be that which 
would accord with the varieties of inflammation, as acute 
and chronic^ or healthy or unhealthy ulcers, to which 
might be added the specific ulcer. Under the first class, 
or the acute or healthy ulcers, I would therefore place 
all those whose natural tendency is to heal, or in which 
there might be noted the ordinary processes of healthy 
inflammation. In the second, or the unhealthy class, I 
would group all those whose tendency is to spread, or 
whose progress corresponds with the ordinary steps of 
unhealthy or chronic inflammatory action. This class 
would embrace the irritable, sloughing, phagedenic, and 
indolent ulcers of other writers. In the third might be 
grouped all such as are dependent on, or modified by, a 



AND GUIDE TO HEALTH. 479 

specific cause, as the cancerous, syphilitic, scrofulous, 
varicose, etc." 

THE ACUTE OR HEALTHY ULCEB. 

Ulcers of this class are sometimes alluded to as " simple 
sores." The edges of these ulcers are characterized by 
their smooth, even and unindented character, resembling 
in this respect the ordinary condition of a wound which 
has been made with a knife in a healthy structure, the 
skin, up to the very margin of the sore, retaining most of 
its characteristics, and not presenting signs of inflamma- 
tory swelling. 

When in the healthy ulcer the process of cicatrization 
has commenced, these edges also often exhibit little pro- 
cesses, or extensions of cuticle over the granulations 
immediately within them. The granulations are of a 
bright, clear, red color, smooth, shining, and covered 
more or less with true pus. They are also somewhat 
conical or pointed in their shape, do not rise above the 
level of the adjacent surface, and do not bleed unless 
roughly touched. 

The discharge is a cream-like pus of a whitish-yellow 
color, which may readily be wiped off the skin adjacent 
to the sore so as to leave no trace of his presence — that 
is, it is unirritating to the skin. The seat of this ulcer 
may be in any portion of the body ; and the patients 
who labor under it are usually the young and middle- 
aged, who possess good constitutions. 

TEEATMENT. 

' The treatment of this ulcer is very simple, the natural 
tendency of the sore being to heal by the process of 
granulation and cicatrization. All that is neceesary is, 
for the dresser to avoid officious interference with the 



480 THE FAMILY PHYSICIAN 

process of nature ; thus, in cleansing the sore let him be 
careful not to wash the pus from off the granulations, 
though he may thoroughly cleanse the skin adjacent to 
them. 

Let him protect the ulcer from any violence or friction, 
if it is so situated as to be exposed, by splints, bandage, 
or by putting the patient to bed, or by approximating the 
edges together by adhesive plaster. 

A degree of heat and moisture must be maintained, 
which can best be done by the warm water dressing, 
which consists of wringing a linen cloth out of warm 
water and applying it to the sore. Or it may be done 
by spreading simple cerate on lint and applying it by 
means of a bandage or something else to retain it in its 
place. 

Poultices were formerly used for this purpose, but 
there are many objections to them; their weight, their 
liability to become rancid, or the chemical changes 
wrought in them often make them injurious. 

The warm water dressing is now in universal use ; . it is 
safe, handy and clean. When in the treatment of the 
acute or healthy ulcer the reparative process begins to 
flag — that is, when the granulations become paler, the 
pus less thick, and the cicatrization does not evidently 
advance— it will prove useful to stimulate the surface by 
touching the margin of the sore very lightly with a stick 
of nitrate of silver, so as to form a white deposit ; and 
this stimulus may be repeated every twenty-four or forty 
eight hours, until the reparative action again advances. 

It may sometimes be necessary to paint the granula- 
tions near the edge of the ulcer with a camel's hair 
pencil which has been dipped in a solution of nitrate of 
silver — ten grains to the ounce of water — or a solution of 
the same strength of sulphate of zinc. 



AND GUIDE TO HEALTH. 481 

Throughout the treatment of this ulcer (if it is one of 
any magnitude) attention should be paid to the digestive 
organs, so that proper nourishment may be had and the 
patient guarded against constipation. 

THE UNHEALTHY OR CHRONIC ULCER. 

" Under this class," says Dr. Smith, " I would group 
all ulcers in which may be traced the ordinary evidences 
of unhealthy or chronic inflammatory action — that is, 
ulcers in which color, heat, pain and swelling are highly 
developed, as well as those in which one or more of these 
signs of inflammation are deficient, or only present in a 
modified degree." Of those in which the heat, pain and 
swelling are marked symptoms, we have the " Irritable," 
the " Sloughing," and the " Phagedenic," as well as the 
"Fungus" ulcers of the older surgeons, while the "In- 
dolent" variety exhibits all the evidences of chronic in- 
flammatory action, with the failure of the reparative 
process of acute inflammation to heal the chasm devel- 
oped by the original source of the ulceration. In the 
class of unhealthy or chronic ulcers is, therefore, placed 
two varieties, the one being marked by excessive inflam- 
matory action, the other by a deficiency of vital force. 

ULCERS DUE TO ACTIVE, UNHEALTHY INFLAM- 
MATION. 

These ulcers are known as the irritating and sloughing 

ulcers. The edges of the skin near the irritable ulcer 

are usually shining, red, hot, painful and swollen, giving 

evidence of high inflammatory action, while the margin 

is serrated or indented in consequence of the burrowing 

of the pus and the absence of the layer of lymph ; the 

granulations may be raised above the skin, bleeding on 
31 



482 THE FAMILY PHYSICIAN 

the slightest touch. The pus, or rather ichor, from this 
variety of ulcer is thin, acrid and irritating, of a pinkish 
yellow from the admixture of blood, or of a light brown, 
like pus — blood and water mixed together. Wherever 
the discharge remains it is disposed to evaporate and 
form crusts or scales, sometimes drying in patches on the 
surface of the sore. The irritable ulcer is generally seen 
on the legs below the knee. 

TKEATMENT. 

The warm water dressing must be applied here as 
directed in the acute ulcer. The patient had better be 
put to bed, and his leg a little elevated, so as to drain 
the blood from it and diminish the local congestion. If 
the pain is severe, add one drachm of opium to half a 
pint of the warm water, and renew it by wetting the cloth 
or lint in it every hour or two. If the whole limb is 
swollen and painful, it may be wet with cold water to 
which laudanum, in the proportion of one drachm to the 
half pint, has been added ; or cold water may be poured 
upon it from the spout of a tea kettle held a foot or two 
above the limb ; but the sore must be dressed with warm 
water dressing. 

When the unhealthy ulcer takes on a sloughing or 
phagedenic character, its progress may be arrested by 
the application of lint wet with very dilute nitric acid, of 
the strength of one drop of the acid to the ounce of water. 
The healing of this ulcer, after it has ceased to be irri- 
table, will often be expedited by the application of lint 
soaked in mucilage — flax seed or gum arabic. 

It is best at the commencement to give a moderate 
cathartic. For this purpose give three of the U. S. Dis- 
pensatory compound cathartic pills. After their action, 
if the ulcer is painful, ten grains of Dover's powder 



AND GUIDE TO HEALTH. 483 

should be given every night at bed time, and the body 
bathed once a day with the tepid alkaline sponge bath ; 
this, with the Dover's powders, will keep the skin in good 
condition. The food must be carefully selected, and 
given in such quantities as will preserve good digestion. 

INDOLENT ULCEBS. 

When the process of repair has been arrested in the 
simple healthy ulcer, or in one of the irritable, sloughing, 
or phagedenic class, the sore may heal to a certain point, 
and then remain unhealed for a period which may vary 
from thirty days to as many years. This kind of sore is 
designated as chronic or indolent ulcer, and the seconds 
species of the unhealthy class. It is generally caused by 
neglecting the simple sore. 

Its seat, like the other class, is the leg below the knee,. 
The pain is trilling, the chief inconvenience being the- 
enlarged, heavy state of the limb. 

TKEATMENT. 

The edges of this class of ulcers will be found to be- 
thick and hard. These must be got rid of. It is the 
custom of some to pare them off with a scalpel or other 
sharp instrument ; they will not bleed much. When the 
everted edges are cut away paint them with a solution 
of nitrate of silver (ten grains to the ounce) ; this will 
cause a new inflammatory action to arise, and the part 
to take on the form of a healthy ulcer. Another plan is^ 
to draw the edges together, or as nearly so as possible,, 
with adhesive straps, and then place a bandage, begin- 
ning at the toes, over it, making considerable pressure ; , 
wet the bandage each morning, or oftener, with cold, 
water, so as to promote evaporation from the limb. 



484 THE FAMILY PHYSICIAN 

Dr. Smith's plan is to apply first a poultice made of 
powdered white oak bark at night, as hot as the patient 
can hear, and have the limb thoroughly washed and 
shaved next morning. Then he recommends to melt to- 
gether fonr parts of beeswax and one part of Venice tur- 
pentine, and when it is cooling to fill the nicer with it, 
the nicer having first been cleaned and dried. Then, 
after the wax has dried, he fastens it in its place by a 
strip or two of adhesive plaster. He then cuts a number 
of strips of adhesive plaster and applies them, commenc- 
ing a little below the sore, and lapping each one about 
one-third on the former one until he gets an inch and a 
half above the sore ; these he draws tightly, making con- 
siderable pressure on the parts. On the third day he 
removes the strips, cleans the pus from the plaster, and 
applies them (or others) again. On the sixth or ninth 
day he removes the strips, and plaster too, and cleans the 
sore ; he then applies the dressing as before, and con- 
tinues this course until it becomes a simple, healthy 
ulcer. 

I have cured some very old and obstinate ulcers by the 
warm water dressing and bandages, commencing at the 
toes and bandaging to the knee, and the painting occa- 
sionally with the solution of nitrate of silver. 

Salves are generally resorted to in domestic practice 
by kind old ladies ; and a common salve, to which red 
precipitate — about twenty grains to the ounce — has been 
added, does sometimes cure an ulcer, but it will oftener 
do harm. If they are applicable at all, it is to this class 
of ulcers ; when they become old and indolent, and want 
life, they need an irritant ; and ointments, I don't care 
how carefully they are made, are scarcely ever free from 
rancidity, and will generally irritate. Much harm is 
often done to irritable or sloughing sores by the applica- 
tion of salve. 



AND GUIDE TO HEALTH. 485 



BOIL FURUICLE. 



The furuncle (from furo to rage), or boil of common 
language, is a circumscribed inflammation of the derm 
or the areolar tissue, which is usually attended by violent 
inflammatory action, followed by the death of the cir- 
cumscribed portion of the skin which is over it and by 
the separation of the central portion from the adjacent 
parts in the form of a " slough," or core, as it is usually 
termed. 

SYMPTOMS. 

The symptoms and general appearance of a boil are 
so well understood by every one that it would scarcely 
seem necessary here to repeat them. The earliest sign 
of its presence will be found in a circumscribed redness, 
attended with considerable burning and a violent throb- 
bing, pulsatile pain, after which swelling occurs, the part 
being raised more or less with a firm, hardened base. It 
soon presents a soft point in the center where pus is 
quickly to be seen like a small pimple, which soon dis- 
charges ; but the boil, although pain diminishes, still 
swells, and finally the skin bursts and a thick, yellow 
pus escapes, leaving in the center a slough called the 
" core." After a few hours or days this core escapes and 
the skin heals rapidly. Generally, after the lapse of a 
few days or weeks, another boil is apt to be located in the 
immediate neighborhood of the first. This also runs its 
course and may be followed by others. 



486 THE FAMILY PHYSICIAN 

TKEATMENT. 

As boils are usually found in those who are free livers 
and whose digestion and secretions are somewhat disor- 
dered, the best plan of treatment is to administer a full 
dose of blue pill at night and follow it next morning by 
a full dose of citratized magnesia or Seidlitz powders, 
repeating the cathartic in twelve hours if its action be not 
quite free. The local treatment should consist in the 
application of heat and moisture by means of the warm 
water dressing, or hot flax seed meal or weak lye and 
wheat bran poultices. When pus is formed (and not 
before) the skin may be punctured and the matter evacu- 
ated, but without disturbing the core, which should be 
left to be thrown off by nature. Great pain and suffer- 
ing is often made by " opening" the boil too soon — that 
is, before the pus is formed. This should be avoided. 
To prevent a reproduction of the complaint the diet 
should be chiefly vegetable and the patient should take 
a dose of salts once or twice a week. 

I do not subscribe to the old saying that each boil is 
worth five dollars to the patient any more than I would 
that each inflammation of the lungs is worth an amount 
to the patient. A boil is simply a symptom — one that 
shows there is a morbid or abnormal condition of the 
system present. Then its pecuniary value is no more 
than any other symptom. 



AND GUIDE TO HEALTH. 487 



CARBUNCLE ANTHRAX. 

FURUKEULUS MALIGNUS. 



This is a malignant form of boil — a gangrenous form 
of inflammation in the areolar tissue. 

SYMPTOMS. 

Pain, fullness and irritation is felt in the part, followed 
by great heat and an intense aching pain ; vessication of 
the cuticle is seen in the part, accompanied by great 
burning. A circumscribed, hard, deep-seated swelling 
can be felt. This soon assumes a dark purple or livid 
color in its center, immediately after which numerous 
vessicated points appear and give exit to a brownish 
sanies (fluid). Shortly after this a little brown or black 
slough shows itself, which seems, from its color and from 
its resemblance to the condition created by the applica- 
tion of a burning coal, to have given rise to the name of 
the complaint. 

As the disorder progresses the various vessicated 
points become the seat of numerous small ulcers through 
which the dead areolar tissue becomes a soft putaceous 
mass, which is ultimately thrown off if the patient sus- 
tains the irritation, thus leaving a wide but superficial 
ulcer, which shows but little disposition to heal. Soon 
after the appearance of the local disorder there is a chill, 
followed by fever, and this is soon succeeded by ty- 
phoid symptoms, inability to sleep, restlessness and 



488 THE FAMILY PHYSICIAN 

headache, or even delirium. There is also difficulty of 
"breathing, colliquative sweats, fainting, subsultus tendi- 
num and hiccough, all of which may terminate in a re- 
turn to health, but which in old persons, and especially 
when the disorder is seated near the head, frequently 
ends in death. 

TKEATMEOT. 

The late Dr. Physick, of Philadelphia, suggested as a 
treatment especially applicable to those cases in which 
there is an evident mortification of the subcutaneous are- 
olar tissue, a crucial (cross) incision entirely through the 
skin, deep into the sloughing tissue ; after which a stick 
of caustic potassa should be rubbed throughout the line 
of the cut across the " sore " and all over the surface of 
the livid skin until it becomes black and is converted into 
an eschar. After this the part must be immediately 
wet with sweet oil or vinegar in order to neutralize the 
caustic, while the surrounding skin, especially that over 
which the discharge will flow, must be painted well with 
sweet oil. This application of the caustic, if thoroughly 
made, destroys all the extreme pain of the disease and 
gives the patient prompt relief. When carbuncle has 
been thus cauterized it should be covered with a ferment- 
ing or yeast and corn-meal poultice, which should be 
renewed every four hours. As soon as the parts show a 
disposition to throw off the dead mass the flax seed poul- 
tice or warm water dressing may be substituted. This 
also must be changed every four hours. After the sepa- 
ration of the slough the ulcer should be treated on the 
general principles of healthy ulcers. It may require six 
or eight weeks to heal it. In the commencement of the 
case, as in boil, a full dose of blue mass may be given 
at night, say fifteen grains, and followed next morning 



AND GUIDE TO HEALTH. 489 

by a dose of Seidlitz powders or salts, after which, the 
patient may use Dover's powders in doses sufficiently 
large to relieve pain. Sometimes two, three or even four 
grains of opium in twenty -four hours may be demanded. 
At the same time the patient's strength must be sup- 
ported by the use of quinine or tincture of barks, gener- 
ous wine and a good, nutritious and easily digested diet. 
As the case advances alcoholic stimulants will become 
necessary. The same plan of treatment must be observed 
in this as recommended in mortification. 



ABSCESS. 



This term is applied by the profession to a circum- 
scribed collection of pus in any of the tissues or organs 
of the body. 

CAUSE. 

The proximate cause of an abscess is almost invaria- 
bly a pre-existing inflammation. An abscess may occur 
in any of the tissues or organs of the body. There are 
two varieties, the acute and chronic. 

SYMPTOMS OE ACUTE ABSCESS. 

" The symptoms of an acute abscess," says Professor 
Smith, of Pennsylvania College, Philadelphia, " may be 
readily understood from the preceding brief account of 
its progress. When the inflammatory action is about to 
result in suppuration, the part becomes redder, hotter and 
more painful and swollen than it was before; then as 



490 THE FAMILY PHYSICIAN 

pit* forms the constitntional symptoms become more 
marked, the formation of the pus. or the establishment 
of suppuration, being often indicated by a chill or rigor, 
and by more or less marked development of the consti- 
tntional symptoms of inflammation. As the pns collects 
the local signs of the presence of liquid become appar- 
ent and fluctuation may be recognized. 5 - The tumor 
also becomes soft and will yield readily to pressure over 
the pus. but will not pit. but fills immediately on your 
taking off the pressure. "When fluctuation is present 
and the evidence of inflammation has been noted, the 
diagnosis of acute abscess is readily made. 

TBEATWEXT OF ACUTE ABSCESS. 

The natural tendency of every acute abscess is to evac- 
uate itself on the side on which the tissues yield most 
readily. In the treatment of acute abscess it will be 
found necessary if there be a foreign substance, such as a 
splinter, leaden ball or anything else in it, to remove it if 
possible, after which such means as have been already 
described for local inflammation should be used — warm 
water dressing. kc. ; but if the mechanical removal of the 
cause can not be accomplished the application of beat 
and moisture must be made, to assist the relaxation of tis- 
sue and the natural tendency of the abscess to point. 
The neatest and best way to do this is by the icarm wa- 
ter dressing. "Wlien pus has formed it becomes neces- 
sary to have it evacuated. This, in most cases, can best 
be done by cutting down on it. This plan is almost al- 
ways preferable in acute abscess, as it will heal more 
readily. Another mode or plan is to open them with 
caustic, or by frequently applying a stick of nitrate of 
silver to the points desired to be opened, and still an- 
other wav bv a seton. The onlv reason, however, for 



AND GUIDE TO HEALTH. 491 

those plans is the danger of cutting an artery or some 
important vessel. This need never be feared if the ope- 
rator is only careful and will only cnt through the skin 
into the abscess. The skin is always sufficiently raised 
to prevent any danger from a careful operation. A bis- 
toury or abscess lancet, or any other sharp instrument, 
may be used. Hold the instrument like a pen, between 
the fingers and thumb, while with the left hand the skin 
at the point of incision is made quite tense, then care- 
fully plunge the instrument only deep enough to pass 
through the skin into the cavity of the abscess, by a for- 
ward and inward motion, and an opening sufficiently 
large to allow a free exit for the pus will be safely made. 
The subsequent flow of the contents of the abscess may 
be then left to nature, or its progress aided by gentle 
pressure, and the subsequent applications of heat and 
moisture. 

The general treatment of an acute abscess will, of 
course, vary with the stage. Before pus is fully formed 
antiphlogistic measures to some extent should be re- 
sorted to. Purgatives may be necessary in order to di- 
minish inflammatory action, but where, after an abscess 
has been opened, there is considerable flow of pus, or 
one which threatens to exhaust the patient's strength, 
the general treatment resolves itself into such measures 
as will support the powers of the system. 

COLD OR CHRONIC ABSCESS. 

This consists in the collection of pus in a circumscribed 
cavity. It resembles the acute ; only the grade of in- 
flammation is so slight that the disorder may pass un- 
noticed for a long time. 



492 THE FAMILY PHYSICIAN 

SYMPTOMS. 

The symptoms of chronic abscess are a dull, heavy pain 
with a moderate amount of congestion in the parts, after 
which a tnmor of varied size shows itself. This may not 
happen, though, for many months. This tnmor is broad, 
and has a hard base, without heat or redness. As this 
augments in size the skin or tissue covering it is rendered 
thinner and softer. The abscess develops slowly; the 
pus collects gradually ; it may be many weeks almost 
without change. The pus of a cold abscess is usually 
imperfectly formed, is greenish, thin and watery, and 
" has a bad smell." 

TEEATMENT. 

"When the amount of pus in a cold abscess is large it 
may, if its contents are evacuated at once, give rise to a 
set of symptoms of a typhoid character. A large cold 
abscess should not, therefore, be emptied at any one 
period, but should be discharged carefully and by de- 
grees, the possibility of the entrance of atmospheric air 
into its cavity being well guarded against. The entrance 
of the atmosphere into the cavity of a cold abscess is often 
most dangerous to life. "When air finds an entrance into 
the cavity of a cold abscess a change is perceived in the 
odor given off by its pus. A train of constitutional 
symptoms may be observed similar to those produced 
by the formation of pus in the blood. The efforts of 
nature to overcome the depression consequent on this 
state of affairs produces a condition of the patient's sys- 
tem which is known under the name of hectic fever. It 
is necessary to delay the opening of cold abscess as long 
as possible without allowng it to open itself; but if from 
the tenseness of the skin it is found that it will soon open, 



AND GUIDE TO HEALTH. 493 

it is always better then to puncture it. When the pus 
has been removed the sides of the abscess should be put 
together so as to bring its walls in contact ; apply a com- 
press and bandages to support them in this position and 
then cany out a plan of general invigorating treatment. 
A good plan to open one of these abscesses is to intro- 
duce the bistoury or lancet at some little distance from 
the cavity and pass it horizontally under the skin into 
the abscess. Bonnet, of Lyons, recommends that the limb 
then be placed in a large vessel of warm water, where, 
of course, the air can not get into it. In a very large 
abscess one-third or one-half of its contents is enough to 
evacuate at a time. Should the air enter the cavity of 
the abscess in spite of all those precautions, and the con- 
sequent typhoid symptoms be developed, the abscess 
should at once be freely laid open, so as to permit the 
pus to have an easy exit, after which its cavity should be 
thoroughly washed out by injecting some solution calcu- 
lated to neutralize the putrefactive process. This should 
be made by adding an ounce of liq. sodse chlorinat to 
six fluid ounces of water, and may be injected three times 
a day. In this condition all the powers we possess should 
be put forth in an invigorating constitutional treatment. 
The best tonics, the best stimulants and the best nutri- 
ment should be carefully used ; the digestive organs must 
be cared for and not over taxed. We must do all we can 
to improve or sustain the system or our patient will sink 
under hectic fever. If hectic fever set in the treatment 
must consist as above — in supporting the system. Tinc- 
ture of iron, other tonics, stimulants, with the best nu- 
triment, such as beef tea, milk, etc., must be resorted to. 



494 THE FAMILY PHYSICIAN 



WHITE SWELLING. 



" In a peculiar form of arthritis met with in the knee 
joint," says Dr. Smith, "and designated as white swell- 
ing, we find the symptoms are as follows : The patient 
notices a certain degree of tenderness about the articula- 
tion, which, gradually developing with the disorder, often 
causes marked tumefaction, and pain of a varied degree 
and duration, this being followed by stiffness of the joint 
and more or less loss of its proper motions. When the 
swollen joint is now handled no sense of fluctuation is 
communicated to the touch, but a peculiar sensation is 
perceived which indicates the presence of a thick gela- 
tinous substance beneath the skin, this substance pre- 
senting a soft, pultaceous mass, which yields somewhat 
to pressure, but does not permit the skin to pit, as in 
oedema, unless accompanied by inflammation of the in- 
teguments." The tumefied joint is usually whitish or 
pearlish in its color, and there is no enlargement of the 
superficial vessels, with no pinkish hue, as in the tume- 
faction of joints due to acute arthritis, rheumatoid arth- 
ritis, or gout. 

The disease progressing, the parts become hot, the 
skin distended and shining, and then a slight vascular 
congestion may be noticed, which gives a pinkish or 
purplish tinge to the tumor. By and by ulcerations 
communicating with the joint are developed in the skin, 
and through these there is discharged a thin, bloody 



AND GUIDE TO HEALTH. 495 

ichor; symptoms of hectic are now developed, if not 
previously present, and the patient becomes prostrated 
by colliquative sweats and diarrhea, presenting not un- 
frequently thoracic disease, till finally death closes the 
scene. Or, a more favorable change taking place, the 
patient survives the exhaustion of the suppuration and 
gets well, with anchylosis of the joint in a deformed 
position. 

TKEATMENT. 

The surface should be often painted with tincture of 
iodine, which must be repeated two or three times a day. 
Rest to the joint must be had, but it is not proper to 
confine the patient to bed, nor even in-doors, as open air 
and exercise is a necessity ; a splint must therefore be 
prepared, so that the limb can be comfortably confined 
in rest while the patient takes out-door exercise. 

Attention must mainly be directed to his general 
health, and all the means usually recommended for sus- 
taining and building up resorted to. Iodide of potassium 
must be given in from two to four grain doses three times 
a day, well diluted in water. 

His bowels must be kept open with injections ; and if 
diarrhea sets in it must be checked by grain doses of 
opium. If he sweats profusely, he must have his body 
washed with water as warm as it can be borne, and take 
twice a day ten or twelve drops of elixir of vitriol in half 
a glass of water. 



496 THE FAMILY PHYSICIAN 



CONVULSIONS. 



It mast be kept in mind that convulsion is a symp- 
tom, not a disease. Yet it is the most striking individual 
symptom of the series in which it occurs ; indeed, it is 
sometimes the only one about which we hare much 
definite knowledge. 

Convulsions occur in association with obvious organic 
changes in the nervous system of the most varied kinds, 
such as cerebral hemorrhage, intra-cranial tumors, and 
softening of the brain. They follow injuries on the head, 
either immediately or remotely, for they are due either 
to the direct effects of the accident, or to the secondary 
effects which, in time, the principle lesion may produce. 
They occur in a healthy but parturient woman after se- 
vere losses of blood, and in an unsound man because his 
diseased kidneys do not allow the waste of the tissue to 
pass from the blood, and thus the body poisons itself. 
Some believe that convulsions may be the result of mere 
passing disturbances in pans of the body remote from 
the brain, such as may be provoked in the nervous sys- 
tem by the irritation of the coming through of a tooth, or 
by worms in the digestive canal. 

Finally, there are a large number of convulsive seizures 
which, for want of knowledge — even of the approximative 
knowledge we have of such cases of fits as are given 
above — we are obliged to dismiss the supposed definite 



AND GUIDE TO HEALTH. 497 

groups of clinical symptoms with the title of epilepsy, 
or epileptiform. 

Whatever else happens it is in all events clear that in 
every convulsive attack nerve tissue suffers ; and the 
practical point, when we are called to a man in a tit, is to 
learn, if not why, at least how, this is suffering. Whether 
it he itself primarily in fault, or whether it suffers from 
want of blood, is poisoned by bad blood, or torn by 
cerebral hemorrhage, there can be but little doubt that 
it is enfeebled. 

CONVULSIONS IN CHILDREN. 

Convulsive attacks in children must, of course, differ 
from one another just as they do in adults. There is 
nothing pathologically different in the convulsions of 
adults and those of children. 

Much slighter causes will produce convulsions in 
children than adults. Our spinal system, at least those 
parts of it of which the actions are involuntary, is more 
nearly perfect at birth ; the brain, the motor and sensory 
centres for the limbs, and all the muscles we use invol- 
untarily, require education. The life of the infant's brain 
is vegetal rather than animal, and so is at first the life of 
its voluntary muscles. The actual physical development 
of nervous organs by growth and junction of cells and 
fibres is not improbably a factor in the formation of 
mind out of brain. The infant can have but a rudimen- 
tary delirium, as its mind is but slightly developed. In 
the language of West, " In a large proportion of cases 
of convulsions in the infant, convulsion answers to de- 
lirium in the adult." Trousseau says that there are child- 
ren who have convulsions as easily as some have delirium, 

or even dreams. So much for the process of development, 
32 



498 THE FAMILY PHYSICIAN 

which gives rise to what is sometimes called the " excit- 
ability" of the child's nervous system. Disease finds 
the nervous system in early life in active change, al- 
though in a healthy, progressive one. 

There are more cases of convulsions in children of 
which our ignorance of the cause is more profound than 
there are in adults. Especially, it is believed, the cases 
are more frequent in which a healthy, or nearly healthy, 
nervous system gives way to some slight external irrita- 
tion. Hence the use of the words " eclampsia " and " es- 
sential" in speaking of the convulsions of infancy. 
There is a great unanimity as to the complete agreement 
of the phenomena of the paroxysms of epilepsy with 
those of convulsive attacks of young children, and it is 
at least premature to say that convulsive attacks at two 
periods of life differ as to their immediate causes, when 
we know nothing certain of the causes of fits at any age. 
" Convulsions may occur at any age," observes Dr. J. 
Hughlings Jackson, "and this remark applies to any 
kind of convulsive movement ; but the tendency to con- 
vulsions gradually decreases with the increasing years." 
In proportion as the brain increases in size, and its struc- 
ture acquires perfection, and its higher functions become 
displayed, convulsions grow less and less frequent. If 
we find the patient to be in general good health, so far 
as we can tell, we should try to find out if there were no 
such temporary cause for the fit as over-eating or fright, 
and we should search for evidence of local irritation, 
such as the cutting through of a tooth, or worms may 
not unfrequently produce them; also pins may be ar- 
ranged in such a manner that by pricking the child 
spasms may be produced. But we more commonly find 
disease of some kind present, such as intermittent fever, 
whooping cough, scarlatina, or some other disease. I 



AND GUIDE TO HEALTH. 499 

can not think, for my part, that over-eating, the irritation 
of worms, &c, or any snch local disturbance, are likely 
to bring on a fit in a child whose nervons system is really 
healthy. And when we find, after getting rid of snch 
causes, that the fits leave and the child gets into appar- 
ent good health, we shonld, I snbmit, bear in mind that 
a feeble, or we may call it an " excitable," nervons sys- 
tem has to be reared, and may again fail when it is next 
tried, although in a very different way. But if, from the 
child's age and other considerations, these local causes 
were not probable, and especially if the child had had 
slight seizures before, we should fear, although we should 
not be certain, that the attack would be followed by 
others, which for want of more knowledge might be called 
"essential," or, as some would call them, epileptic. 
When technical terms are allowed to govern our thoughts 
it is very important how we name a series of symptoms. 
One thing is perfectly certain, that epileptic fits in adults 
frequently date from convulsions in infancy. 

TKEATMENT. 

" It would not be correct, as I have remarked," observes 
Dr. Jackson, " to speak of any truly rational treatment 
of a single symptom which means things very different. 
Our treatment is nearly altogether empirical. I, of course, 
exclude altogether from present consideration cases in 
which convulsions occur in such diseases as scarlet fever, 
meningitis, etc. Even an empirical treatment of convul- 
sions would not be justifiable in these instances. I have 
no doubt whatever in time we shall cease to consider any 
sort or degree of convulsion as in any way a separate 
thing for diagnosis, prognosis or treatment. Our thoughts 
on treatment would go hand in hand with our investiga- 
tions, and of course principles of treatment apply to 



500 THE FAMILY PHYSICIAN 

convulsions of all sorts, from rolling of the eyes to com- 
plete seizure. If we find the child in a fit we should see 
that every part of its dress is loosened, that it has a 
plentiful supply of pure air, and we should direct that it 
Ibe laid down and kept quiet. If we find that the fit came 
on after eating, we should give an emetic of ipecac — to a 
child one year old one or two grains in a teaspoonful of 
warm water. If we find a gum swollen or tense, we might 
properly use the lancet and cut it. "We should inquire 
after the state of the child's Ibowels ; if they are costive 
we should give a purgative. But none of these things 
must Ibe done as a matter of routine. The presence of 
diarrhea, especially with griping and passing nothing 
but mucous, may show that there is irritating matter in 
the intestinal canal, and it is then proper to give a dose 
of castor oil, injections of warm water or gruel — an ounce 
to a child one year old will be found serviceable to facili- 
tate an action of the bowels. Warm baths should be 
used when there is no great heat of the skin and no tho- 
racic complications. The child may be put in a bath 
with the temperature at 95 to 100 ° Fahr. from five to ten 
minutes. Under any circumstances the feet and legs 
may be immersed in hot water, then mustard plasters 
applied to the calves of the legs for five or ten minutes. 
If the patient has high fever, as is often the case, the 
body should be sponged with tepid alkaline water often 
and cold applied to the head. It would not be proper to 
immerse his body in hot water if there is great fever." 
When we have done all that immediate investigation 
prompts — when we have attended to the bowels, lanced 
the gums, ordered proper food, the convulsions may per- 
sist, and may even increase in number, in spite of all our 
care, and we are thus urged to do something more. It 
is then that this sort of convulsion has its chief im- 



AND GUIDE TO HEALTH. 501 

portance. There is in attacks of convulsions a tendency 
to (1) death "by exhaustion, from the frequency of the fits 
and want of sleep ; (2) death from asphyxia (non-conver- 
sion of venons blood in the lnngs into arterial blood — sus- 
pended animation) ; suddenly from the prolonged fixing 
of the chest walls, and gradually from slow congestion of 
the lungs. The latter is rather a way of dying than a 
cause of death. Adults die from convulsive seizures in 
each of those two ways. 

" If the child were much exhausted by frequent fits, or 
if it were weak from the first, had long had diarrhea," 
says Dr. Jackson, " I would look most carefully to its 
support. I should prescribe beef tea or juice of meat in 
abundance. Nor would I hesitate to give stimulants. 
Tlie object in treatment of disordered function of the 
brain is to produce sleep. To accomplish this we should 
give support liberally, and if this fail, stimulants freely. 
If the beef tea or juice of meat were vomited, give milk 
with a little ice and inject the tea or the juice. Of course 
I speak of fits when there is no general fever and no 
sign of inflammation of the membranes. A thin, delicate 
child should be kept warm. As an anti-spasmodic it 
may be desirable to inject thirty drops of tincture of 
assafetida in an ounce of warm milk for a child from 
six months to one year old. A mixture containing 
hyoscyamus, two or three drops for the age of six weeks, 
may be given with peppermint water. The great object, 
however, is, I repeat, to produce sleep." I would prefer 
to accomplish the object without wine — "by nutrients, if 
possible ; but to a weak child I would not hesitate to give 
the wine, as we have the very best authority there is for 
it. Should nutrients and stimulants fail, I would not 
hesitate to give opiates. In a case where there was great 
excitement with little vigor I should not give narcotics. 



502 THE FAMILY PHYSICIAN 

Narcotics should not be used oftener than once in twelve 
hours, and not then when there is great febrile excite- 
ment. A decided dose should be given — a quarter of a 
grain of Dover's powder under the age of three months, 
half a grain to one year, and a grain to one year and a 
half or two years. Inhalations of chloroform have been 
recommended by some of the best physicians of the age 
when convulsions are not obviously due to organic dis- 
ease of the brain. Convulsion is a sign of enfeeblement 
of part of the nervous system. If spasms become chronic, 
bromide of potassium is the remedy — a quarter of a grain 
under six weeks, half a grain under three months, a grain 
above that age, and a grain additional for every year. 



EPILEPSY-FITS. 



This is a chronic disease, of which the characteristic 
symptom is a sudden trouble or loss of consciousness, 
this change being occasional and temporary, sometimes 
unattended by any evident muscular contraction, some- 
times accompanied by partial spasm, and sometimes by 
general convulsion. 

The two elements probably present in every case of 
epilepsy are, diminution of intelligence and excess of. 
muscular contraction ; and these two elements may exist 
in almost every variety of combination and.be developed 
to any degree of intensity. 

CAUSES. 

Dr. Reynolds has found hereditary taint to exist in 
rather less than one-third of the cases that have come 



AND GUIDE TO HEALTH. 503 

under his observation ; and he states that he has been 
careful on this point. 

Besides this, there are various forms of nervous malady, 
and other abnormal conditions of the sexual organs, or 
unnatural circumstances attending upon their exercise. 

Epilepsy commences in a majority of cases between 
the ages of ten and twenty years, or about the period of 
second dentition or puberty. Fright, grief, over work, 
eccentric irritation, dentition, indigestion, venereal ex- 
cesses, blows on the head, &c., are the principal causes 
that have been assigned for epilepsy. 

SYMPTOMS. 

u In the most characteristic cases of epilepsy," observes 
Dr. Reynolds, " there is an entire loss of consciousness, 
in conjunction with a peculiar series of involuntary mus- 
cular movements ; but on the one side of these typical 
cases we see epileptics in whom the loss of consciousness 
is alone obvious ■, and on the other individuals exhibiting 
highly marked spasmodic phenomena, and only very 
slight, or even imperceptible, obscuration of the mind." 

There is a wide range in the severity of attacks of epi- 
lepsy. Thus the patient may only have a sudden, 
temporary, but absolute arrest of both perception and 
volition. The individual so attacked loses consciousness 
for two, three, or more seconds, and may, after that or a 
longer period, resume his sentence or employment per- 
fectly unaware that anything abnormal has happened. 

These seizures are often regarded as " faintings," and 
are described by patients as "blanks," "forgets," "faints," 
"sensations," "absences," "darknesses," etc. Sometimes 
there may be only a drawing of the mouth, partial turn- 
ing of the head to one side, or some movement as if 
swallowing, etc., or there may be slight momentary 



504 THE FAMILY PHYSICIAN 

rigidity of the whole body. Sometimes tlie patient does 
some curious things, snch as to stoop down to peep under 
a sofa, lie down and pull off his cravat, jump from his 
chair and walk quickly half way across the room ; Ibut 
in any or all of these attempts to do something he is sud- 
denly arrested "by the loss of consciousness, which is often 
absolute. The loss of consciousness is generally sudden 
and complete, the patient falls down in a moment, with or 
without warning ; but, even when the warning occurs, so 
that he may change his position or call attention to his 
wants, habitually the passage from consciousness to un- 
consciousness is abrupt and the loss absolute. 

The tonic spasm of the muscles is peculiar. The patient 
usually appears to be straining round toward one side, 
as if striving to look over and behind one of his shoulders. 
The eye-balls, the head, the arms and the trunk turn and 
twist round so as to give the impression above mentioned. 
Respiration is arrested, the patient appearing just like a 
man forcibly holding his breath. In a few cases the 
breathing proceeds without actual interruption, but its 
movements are diminished in force. 

The pulse, as felt at the wrist, is usually small. The 
pupils of the eye are dilated. The breathing later in the 
attack becomes laborious, with a gurgling and foaming. 
The face, from being pale at first, becomes dark. The 
attack is followed by sleep. 

TKEATMENT. 

For the treatment of epilepsy sedatives have been em- 
ployed, and with success. It would be useless to attempt 
any estimate of the relative value of many of these 
agents, for there are no data sufficient for the purpose. 
Opium or morphia, hyoscyamus, stramonium, belladonna, 
cannabis Indica, atropine, chloroform, and other medi- 



AND GUIDE TO HEALTH. 505 

cines, liave been employed with good effect in some 
cases, but without any perceivable effect in others ; and 
hitherto no principle has been evolved from either their 
failure or success. Opium, or some preparation of 
morphia, has been of service when the patient was rest- 
less at night, and was obviously suffering from loss of 
rest. 

Chloroform has delayed attacks while the patient was 
actually under its influence, but has failed to prevent 
their subsequent recurrence. More recently bromide of 
potassium has gained great favor in the treatment of epi- 
lepsy ; in fact, it is well established now on the very best 
authority that it will always help, and really most gen- 
erally cure the complaint. This is indeed a valuable ac- 
quisition to medical science. The disease has long been 
considered as almost incurable. Few cases indeed have 
ever been cured by the ordinary means that have so long 
been employed. But now we have a remedy (not a spe- 
cific) in the bromide of potassium, upon which we may 
rely most confidently. « 

Dr. Reynolds, in his excellent " System of Medicine," 
observes, " Bromide of potassium is one medicine which 
has, so far as I know, proved of real service in the treat- 
ment of epilepsy." Undoubtedly it is sedative in its ac- 
tion; it lessens spasmodic movements of almost every 
kind, and sometimes insures sleep when vegetable seda- 
tives, and among them opium, have failed. Bromide of 
potassium in small doses has appeared to be of little or 
no service, but in large doses it has scarcely ever failed 
to give much relief. 

Sir Charles Locock has the merit of introducing this 
drug to the notice of the profession {Lancet, May 20, 
1857), and the testimony of all those who have had much 
experience in the matter concurs in a remarkable degree 



506 THE FAMILY PHYSICIAN 

to its utility. Given in doses to an adult ranging from 
ten to thirty grains, three times daily, it has had these 
effects : In some cases it has completely cured the pa- 
tient, and the cure has been permanent. In other cases 
it has arrested the attacks, so that none have occurred 
for periods varying from a few months to two or three 
years ; hut on the omission of the medicine the seizures 
have returned. In such cases the attacks have again 
ceased on the readministration of the medicine. In a 
third series of cases it has diminished the frequency 
and severity of the seizures, but has not removed them 
altogether, the patients while using the bromide having 
had one-half or one-third of their habitual number. 

Dr. Eeynolds further adds : " It is to be demonstrated, 
in my opinion, that there is something specific in the 
action of K. Br. potassium. Given as an iodide it is with- 
out much effect ; and bromide, given as bromide of amo- 
nium, has no obvious influence upon epilepsy ; but in 
combination these two " elements" — "bromide and potas- 
sium — are of undoubted value." 

The Doctor does not think that it exercises any influ- 
ence, as used above, on the sexual organs, either for pro- 
pensity or power, but that it is positively curative of 
epilepsy when given in doses as above recommended. 
He further states that he has given it to hundreds of 
individuals and has witnessed no ill effects from its ad- 
ministration. 

"As to diet," continues Dr. Reynolds (I quote him be- 
cause I think there is no better authority), " and regimen, 
these things seem to me important : first, that the patient 
should eat digestible meals with great regularity ; and 
second, that exercise in the open air should be taken as 
much as possible short of fatigue. Many epileptics have 
been relieved from nocturnal attacks by being made to 



AND GUIDE TO HEALTH. 507 

sleep with the head and shoulders well raised, not by 
pillows, hut by a simple contrivance which is placed 
under the upper half of the bed or mattress on which 
they lie. Baths used for the purpose of cleanliness are 
useful in epilepsy as in many other diseases ; but I have 
seen more harm than good follow the employment of the 
douche, shower and sitz baths when they have been ad- 
ministered in any manner or to any degree which Exceeds 
that of producing comfort to the individual. Warmth to 
the extremities, especially at night, is of great value ; the 
patient should never go to bed with cold feet, or run the 
risk of their becoming cold during the night. Fires, hot 
water, hot water baths and woolen socks may prevent 
mischief. Sexual intercourse appears to me also to be 
one of those matters upon which the dictates of common 
sense are sufficient without any special direction from 
the physician." 

It is impossible to pay too much attention to the gen- 
eral health of the epileptic, but there is nothing special 
in regard to this matter. Cod liver oil, quinine, iron, 
alteratives and aperients must be given in circumstances 
when their exhibition would be desirable in other forms 
of disease. Ice applied to the spine has been recom- 
mended by Dr. Chapman, but Dr. Keynolds has never 
seen any good results obtained from it, and he has known 
it to be applied for months. When a paroxysm is over 
the patient should be allowed to sleep, and should always 
be placed with his head and shoulders raised. 



508 THE FAMILY PHYSICIAN 



ASTHMA-PHTHISIC 



Asthma is a spasmodical contraction of the muscular 
fibres of the bronchial tubes. It comes on at certain 
periods, generally at night. It is frequently preceded for 
days by warning symptoms. There are two species — the 
dry, nervous, or spasmodic asthma, and the humid or 
habitual asthma. 

SYMPTOMS. 

A sense of fulness is felt as a premonitory symptom 
about the stomach, with lassitude, drowsiness, headache, 
flatulency, nausea and pale urine. The patient begins 
to experience a sense of tightness across the chest, with 
difficult breathing and a wheezing sound; there is a 
tendency to cough, with some difficulty of speech. The 
symptoms progress rapidly, become more alarming in 
their character, and threaten suffocation. A cold per- 
spiration oozes from the body. 

There is generally some remission of these symptoms 
toward morning, the breathing becomes more free, 
coughing and speaking less difficult, expectoration takes 
place more freely, and the patient generally falls asleep. 
The difficulty may not be severe again through the day, 
though still present to a disagreeable extent, but toward 
night all the troublesome symptoms again return, and 
sometimes in an aggravated form. The paroxysms and 
remissions may continue in this way for several days. 



AND GUIDE TO HEALTH. 509 

TKEATMENT. 

For tlie relief of a paroxysm take unglazed paper and 
dip it into a saturated solution of nitre, let it soak fifteen 
minutes, then dry it and fold it in an oven, ignite one 
end and let it slowly burn in a close room in which the 
patient is seated, so that he can inhale its fumes. This 
may he repeated occasionally. The paper should he 
kept prepared by persons subject to the disease. While 
preparations are being made for this the patient's throat 
and the upper part of his chest must be well bathed with 
a stimulating liniment made as follows : Take oil of 
origanum, two drachms ; alcohol, an ounce ; olive oil, an 
ounce ; aqua ammonise, half an ounce ; chloroform, half 
an ounce. Mix, and apply to the throat and neck with 
considerable friction, and place the feet in a warm bath. 
The patient should take internally two to four grains of 
assafcetida and as much powdered camphor every hour 
or two. 

This course will generally cut short the spasm or par- 
oxysm. This we may term palliative treatment. But 
we can do more ; we can cure the disease. 

When the paroxysm is over we should commence a 
strict system of hygiene. We must attend to the skin 
by the use of proper baths, to the stomach and bowels 
by a proper course of diet, and take good exercise. The 
patient must eat wholesome, digestible food; he must 
keep his feet warm, and wear warm clothes in the winter 
or cold weather ; he must not sleep in a cold or damp 
room ; he must keep away from a hay loft ; he must be 
temperate in all things, and do all he can to promote his 
general health. In addition to this, one simple drug ju- 
diciously used will cure astlima, if it is uncomplicated 
or not dependent on other disease. This drug is bromide 



510 THE FAMILY PHYSICIAN 

of potassium. It may "be taken three times a day, in 
from four to eight grain doses. It can be taken in pills 
or solution ; but must be continued for months. It would 
probably be as well to commence with three grain doses, 
and every month increase a grain until you get up to 
eight grains. 

This course maybe pursued with great confidence; the 
result will justify the pains. The oldest and most ob- 
stinate cases will yield to this plan strictly followed out. 

The bromide of potassium in medicinal doses is in- 
nocent and harmless, with one exception : it sometimes 
acts as an antaphrodisiac ; but this will be well for the 
patient, as almost all asthma is confined to men, and 
their cure will be facilitated by it. 

It will be observed in this work that I do not often 
offer specifics, nor do I in this case, only on condition 
that the proper laws of health are rigidly observed ; but 
if they are, I would be much inclined to offer bromide of 
potassium as one for this troublesome disease, asthma. 

There is a certain school of practitioners that offers 
lobelia and capsicum as a specific for asthma ; but every 
one has seen them fail so often and so signally, even to 
palliate, that confidence is pretty much lost in them. 
Both are excellent remedies, however, when indicated ; 
capsicum particularly is a most excellent stimulant. 

Bromide of potassium, I omitted to mention in the 
treatment of the paroxysm, is now well known by 
those who have tried it to be one of the best, if indeed 
not the very best, antispasmodic and calmative medicine 
now in use ; therefore its administration in the paroxysm 
of asthma, or any other spasmodic affection, is proper, 
and will be followed with benefit. 



AND GUIDE TO HEALTH. 511 



TETAIUS---LOCKED-JAW. 



This is a nervous disorder, characterized by spasm. It 
is caused generally Iby wounds of the nerves, tendons, 
fascia?, and comparatively superficial parts. Lacerated 
and punctured wounds are more apt to create it than the 
other classes. I have known several bad or fatal cases 
of tetanus from a wound by a rusty nail in some parts of 
the foot. 

SYMPTOMS. 

There is first, at a period which varies greatly after the 
reception of the wound, a soreness in the muscles of the 
jaw, which feels as if the patient had been eating some- 
thing hard and was tired. This stiffness soon spreads to 
the muscles of the neck, producing the sensation of " stiff 
neck," such as is caused by a draught of cold air. A 
peculiar expression of countenance is then observable, 
which may be characterized as a painful smile, and is 
due to the, fixed contraction of the zygomatic muscles. 
At the same time the eyes have a peculiar look — they 
stare, and are gathered at the corners. The affection of 
the muscles of mastication soon becoming more marked 
the masseter contracts so powerfully that the jaws can 
not be opened, while the saliva or liquid can not be swal- 
lowed on account of the muscles of deglutition being in- 
volved. A pain in the stomach now comes on, as if an 
attack of colic were about to begin, and the diaphragm 
is soon affected, the patient suffering from difficulty of 



512 THE FAMILY PHYSICIAN 

"breathing and a spasmodic pain along the insertion of 
the diaphragm. The abdomen next becomes hard and 
knotted, presenting the appearance of a tumor, from con- 
traction of the recti muscles, while from spasm of the 
muscular coat of the bowels constipation and difficulty 
of passing urine ensue. Meanwhile the intellect of the 
sufferer remains clear and the pulse natural. If the par- 
oxysms continue they become more violent, and the pa- 
tient dies in a period varying from two to fourteen days, 
the shorter period being rarely seen. The prognosis of 
tetanus or locked-jaw is very unfavorable. The French 
aphorism is, " Tants des cas, tants des morts" which 
means so many cases, so many deaths. This, however, 
is not indorsed in this age and country. 

TEEATMENT. 

The treatment of tetanus may be divided into — first, 
prophylactic or preventive ; second, palliative and cura- 
tive. 

"When locked-jaw is feared it is recommended to 
divide nerves that have been merely pricked. If the sore 
seems to be ill conditioned it must be thoroughly cauter- 
ized by the stick of nitrate of silver and then dressed 
with warm dressing. On account of the trismus and 
spasm of the pharyngeal muscles it is almost impossible 
to administer a sufficient amount of medicine and nour- 
ishment to the patient to sustain life, which difficulty is 
also increased by the fact that the muscular coat of the 
alimentary canal does not propel the food through it, 
owing to the continuous spasm which characterizes the 
disorder. 

Dr. Watson says : " In all cases, there being no special 
indication to the contrary, I should be more disposed to 
administer wine in large quantities and nutriment than 



AND GUIDE TO HEALTH. 513 

any particular drug." This conclusion he arrives at 
after passing in review the principal remedies that have 
been tried in tetanus — opium, blood letting, the cold bath, 
ice to the spine, warm bath, bark, mercury, purgatives, 
foxglove, tobacco, musk, prussic acid, carbonate of iron, 
strychnine, ether, etc. 

If the present theory of spasm be correct the great 
indication of treatment must be not to depress the circu- 
lation, but to rouse it into greater activity ; and one reason 
why the treatment of tetanus has been so eminently un- 
satisfactory is, to my mind, that this indication has not 
been fully realized and carried out. 

Dr. C. B. Radcliffe, in his article on the treatment of 
tetanus, says : "In tetanus much wine may be given 
without producing anything like intoxication, or without 
relaxing the spasm in any degree." The system in this, 
disease is altogether insensible to wine in ordinary doses. 
As to this there can be no doubt. There are not a few 
cases on record which show that the bite of a rattlesnake 
or cobra or other deadly serpent may be prevented from 
killing by at once giving ardent spirits in sufficient quan- 
tity, and I am disposed to think that these facts have an 
important bearing upon the treatment of tetanus. There' 
are, undoubtedly, great differences between the condition; 
in tetanus and the condition in these poisoned bites, but' 
there are also certain resemblances which must not be 
lost sight of. There is the same insensibility to the ac- 
tion of alcohol in ordinary doses ; there is an exhaustion 
to be counteracted which is more rapidly fatal in the 
poisoned bite than in tetanus, but which in acute tetanus 
is sufficiently rapid to create the gravest fears and to> 
justify the most heroic measures. There may even be a 
poison at work in both cases, as well as a wound — a poi- 
son introduced into the wound in one case, a poison gen- 
33 



514 THE FAMILY PHYSICIAN 

erated in the wound in the other case. There are resem- 
blances between the two cases, indeed, which though not 
very close, may be close enough to justify the hope that 
a practice which has been found to answer in the bite of 
a poisonous serpent may also be found to answer in acute 
tetanus. 

Now, as the evident tendency of this disease is to death 
by depression, can there be a more rational treatment 
instituted than a sustaining one ? Good brandy, then, 
or whisky, must be freely given ; if it can not be given by 
the mouth it must be given by means of injections, and 
given in either case in connection with good beef tea, 
This course must be pursued until the system is im- 
pressed. The life of the patient depends upon sustenance 
and rousing. For this purpose no better means than 
those can be used. 

While this treatment is given, the powerful calmative 
and antispasmodic, bromide of potassium, must be used 
in six or eight grain doses, three times a day, in connec- 
tion with medium doses of opium or morphine — three- 
fourths of a grain of the former, or one-fourth of a grain 
of the latter. Larger doses of opium must not be given ; 
we only want its stimulating and anodyne effects, not its 
sedative. If it has to be administered by injection, 
double the quantity of the opium, and also the bromide 
of potassium. 

The patient must be carefully guarded from cold and 
from anything that will excite or disturb him. In a 
word, quiet and warmth are not only desirable, but in- 
dispensable. 

Such a course of treatment in tetanus will be found to 
be more satisfactory and more successful than anything 
heretofore offered. 



AND GUIDE TO HEALTH. 515 



COLIC-ENTERALGIA. 



This term is usually applied to any griping pain of 
the bowels. It has been divided into three forms — the 
flatulent^ bilious and painters colic. 

It is a spasm of the muscles of the abdomen or stomach, 
caused always by irritation. An irritating cause is ap- 
plied to the peripheral extremities of the nerves of the 
stomach or bowels, and the spasm is caused by the 
eccentric or reflex action. 

Then the cause of colic must always be the presence of 
some irritating substance in the stomach or bowels. 
With this view of the case, the treatment is readily sug- 
gested, which is to remove the irritating cause by emetics 
or cathartics, or both, and then use calmatives and anti- 
spasmodics. 

SYMPTOMS. 

Violent pain in some part of the abdomen, with a sense 
of twisting or griping about the navel. The pain is not 
increased by pressure, and presents all the characteristics 
of spasm, by partially subsiding at times. There is ful- 
ness and distention of the abdomen, costiveness, nausea, 
cold extremities, and sometimes a rumbling noise in the 
bowels. The pain sometimes shifts about in the bowels, 
and is somewhat relieved by the escape of wind. 



516 THE FAMILY PHYSICIAN 

TKEATMENT. 

If colic occurs soon after a meal, and you have reason 
to believe that crude substances are in the stomach pro- 
ducing irritation, give an emetic of twenty grains of 
ipecac in four ounces of warm water. As soon as this 
has operated give an injection of four ounces of castor 
oil with as much warm water. This should he thrown 
well up into the bowels, and repeated frequently until a 
free operation is had. 

In the meantime, and as soon as the emetic has ope- 
rated, give to an adult one-third of a grain of morphine 
and eight grains of bromide of potassium ; if this does 
not give relief in two hours it may be once repeated, 
and in another hour give a large dose of castor oil — two 
or three ounces — to which fifteen or twenty drops of 
spirits of turpentine have been added. 

If, however, it does not appear that the irritating cause 
is in the stomach, but in the bowels, a cathartic is the 
first thing to be given. It so happens sometimes that it 
is almost impossible to get an ordinary cathartic to act ; 
when this is the case, and the attack is at all severe, I 
would recommend the administration of the following : 
Take croton oil, four drops ; crushed sugar, one tea- 
spoonful ; mucilage of gum arabic, one ounce. Of this 
give a teaspoonful every fifteen minutes until it operates 
on the bowels. As soon as this is had give the morphine 
and bromide of potassium. 

The above treatment will answer for the flatulent and 
bilious colic. Painter's colic is treated of elsewhere. The 
object, it will be seen, is to clear the stomach and bowels, 
removing the irritating cause, and then relieve the spasm 
by the anodyne (morphine) and the antispasmodic and 
calmative (bromide of potassium). This is the rationale 
of colic. 



AND GUIDE TO HEALTH. 517 



PHTHISIS PULMONALIS. 

(CONSUMPTION.) 



In this terrible disease the tubercle at first is deposited 
in a state of fluid exudation from the capillaries, in 
the same manner that lymph is. In this condition it 
insinuates itself into the interstices of the pulmonary 
texture, passes through the lining membrane of the air 
vesicles and fills their interior. A miliary tubercle may 
in this manner block up from three to twenty of these 
air vesicles. It now coagulates and constitutes a foreign 
solid body, which can only be removed by being again 
broken down and rendered capable of being either 
absorbed or excreted. Thus the miliary or infiltration 
forms ; whether grey or yellow after a time it softens — a 
process which may commence at any part of the mass 
and gradually affect the whole. This softening is a 
disintegration or slow death of the tubercular exudation, 
constituting true ulceration, which is more or less exten- 
sive, according to the amount and extent of the morbid 
deposit. When recent the pulmonary texture in the 
immediate neighborhood is more or less congested, and 
when chronic it is thickened and indurated, often form- 
ing a capsule which surrounds the tubercular deposit. 
The bronchi are necessarily involved ; their terminal ex- 
tremities are among the first structures affected, and as 
the tuberculosis proceeds all the appearances charteristic 



518 THE FAMILY PHYSICIAN 

of chronic bronchitis are produced. As the ulcerative 
process extends the lung is more and more destroyed, 
the excavations become larger and more numerous, until 
at length it can no longer carry on its important functions 
and the patient dies, or the fatal result, as very commonly 
happens, is hastened by disease in other organs. The 
ulceration or destructive tendency of the tubercular exu- 
dation is often checked and for a time slumbers, and even 
in the worst cases of tubercular lungs numerous cicatrices 
and evidences of attempts to heal may be seen by post 
mortem examination. These attempts are more or less 
perfect, and when ineffectual it is owing to the circum- 
stance that as one portion of the lung cicatrizes another 
becomes the seat of recent tubercle. 

Dr. Bennett observes : " If, then, the further deposition 
of tubercle could be arrested, there seems no reason 
why cavities in the lung should not heal with the same 
frequency as ulcerations or abscesses in other internal 
organs. Indeed, the careful dissections of morbid anato- 
mists have recently shown that this arrestment, instead 
of being a rare or occasional occurrence, really happens 
with extreme frequency." 

Dr. Bennett made a series of observations with refer- 
ence to this subject, and the conclusion he arrived at was 
that the spontaneous arrestment of tubercle in its early 
stage occurred in the proportion of from one-third to one- 
half of all the individuals who die after the age of forty. 
The observations of Rogee and Boudet, made at the 
Salpetriere Hospital, in Paris, amongst the individuals 
generally above the age of seventy showed the propor- 
tion in such persons to be respectively one-half and four- 
fifths. Dr. Bennett gives a case of a young man who at 
the age of twenty-two or twenty-three must have had an 
ulcer in the right lung of very considerable size, for when 



AND GUIDE TO HEALTH. 519 

he died of delirium tremens at an advanced age it was 
found that the cicatrix in the lung was three inches long. 
The Doctor observes: u It is, therefore, very probable 
that the statement made by his friend at the examination 
was correct — namely, that when young he labored under 
all the symptoms of advanced phthisis pulmonalis, and 
that after receiving the appointment of a parish school- 
master and changing his residence and occupation, and 
his social condition being greatly improved, these symp- 
toms disappeared. It was about this period that the 
excavation on the right side healed and the tubercular 
exudation on the left side was converted into cutaneous 
masses and so rendered abortive." 

Dr. Bennett further observes : " Although the curabil- 
ity of phthisis pulmonalis, even in its most advanced 
stage, can now no longer be denied, it has been argued 
that this is entirely owing to the operations of nature, 
and that the physician can lay little claim to the result." 

Andral, who early admitted the occasional healing of 
caverns, states this in the following words : " No fact 
demonstrates that phthisis (consumption) has ever been 
cured, for it is not art which operates in the cicatrization 
of caverns ; it can at most only favor this by not oppos- 
ing the operations of nature. For ages remedies have 
been sought either to combat the disposition to tubercles 
or to destroy them when formed, and thus innumerable 
specifics have been employed and abandoned in turn, 
and chosen from every class of medicines. — Diet, de 
Med., 1st Edit. PhtMsie. But if it be true that " Medi- 
cus natures minister non magister est" as Hoffman says, 
it follows that by carefully observing the operations of 
nature, learning her method of cure, imitating it as 
closely as possible, avoiding what she points out to be 
injurious, and furnishing what she evidently requires, we 



520 THE FAMILY PHYSICIAN 

may at length arrive at rational indications of treatment. 
The cases of both Keith and Barclay, as reported by Dr. 
Bennett, furnish evidence that we have in a great meas- 
ure attained this end. 

SYMPTOMS. 

Phthisis pulmonalis is ushered in with a bad and ca- 
pricious appetite, a furred or morbidly clean tongue, un- 
usual acidity of the stomach and alimentary canal, con- 
stipation alternating with diarrhea, and a variety of 
symptoms denominated dyspeptic. These symptoms in 
a great majority of cases accompany the disease through 
its whole course. Cough is a very early symptom, and 
one that becomes more troublesome as the disease ad- 
vances, morbid expectorations, pains in the heart, occa- 
sional heat in the hands, feet and cheeks, shortness of 
breath on exertion, and sometimes profuse hemorrhage. 
It must be remembered, however, that bleeding from the 
lungs is not always a sign of consumption. The emaci- 
ation increases, the features present a sharp appearance, 
the eyes seem hollow and languid, hectic fever, &c. 

It is impossible in the earlier stages of consumption to 
make a correct diagnosis without a stethoscope. Aus- 
cultation and percussion is the only correct mode of de- 
termining pulmonary disease, but in order to be able to 
use these modes to advantage some experience is abso- 
lutely necessary. 

CAUSES. 

An observation of the circumstances which precede the 
disease or its so-called causes clearly indicates imperfect 
digestion and assimilation as its true origin. Thus 
phthisis is clearly a disorder of childhood and youth — 
that is, the period of life when nutrition is directed to 



AND GUIDE TO HEALTH. 521 

builing up the tissues of the body. Dimmish the proper 
amount of food taken "by a healthy adult and tubercular 
diseases are not induced ; but if this be attempted with 
children or young persons, they are a most common re- 
sult. It has been supposed that a hereditary predisposi- 
tion, a vitiated atmosphere, changeable temperature, cer- 
tain unhealthy occupations, humidity, particular locali- 
ties, absence of light, and so on, predispose to consump- 
tion. Very frequently several of these are found united, 
so that it is difficult to ascertain the influence of each. 
When they so operate, however, they invariably produce, 
in the first place, more or less disorder of the nutritive 
functions, and are associated with dyspepsia or other 
signs of mal-assimilation of food. 

TEEATMENT. 

Dr. Bennett observes : " From a study of the symp- 
toms, causes, morbid anatomy and histology of phthisis 
pulmonalis we are therefore led to the conclusion that it 
is a disease of the primary digestion, causing — first, im- 
poverishment of the blood ; second, local exudations into 
the lung, which present the characteristics of tubercular 
exudations ; and third, owing to the successive formation 
and softening of them the ulceration which follows in the 
pulmonary or other tissues, causing the destructive results 
which distinguish the disease. Further observations show 
that circumstances which remove the mal-assimilation of 
food frequently check further tubercular exudations, 
while those which previously existed become abortive, 
and that occasionally very extensive excavations in the 
pulmonary tissue may, owing to like circumstances, heal 
up and cicatrize. The curative treatment of this disease 
must therefore be directed — first, to restoring the healthy 
nutrition of the economy ; second, to subduing local irri- 



522 THE FAMILY PHYSICIAN 

tation ; and third, to the avoidance of those circumstances 
which are likelv to deteriorate the constitution on the one 
hand or induce pulmonary symptoms on the other." 

All kinds of food rich in fat will often be found bene- 
ficial, hence the value long attributed to milk, especially 
ass' milk, the produce of the dairy, as cream and but- 
ter, fat bacon, etc. But it is not always that such sub- 
stances will be digested and they lie in the stomach or 
are vomited. Under these circumstances the animal oils 
themselves are directly indicated, by giving which we 
save the digestive apparatus, as it were, the trouble of 
manufacturing or separating them from the food. By 
giving considerable quantities of oil directly a large pro- 
portion of it at once is assimilated and is rendered 
capable of entering into combination with the albumen 
(which is always in excess in the consumptive) when it 
forms those elementary molecules so necessary for the 
formation of a healthy chyle. Such is the rationale of 
the good effects of cod liver oil. Dr. Bennett introduced 
the cod liver oil in 1841 in the treatment of consumption, 
and speaks in glowing terms of its success. The cod 
liver oil is readily digestible under circumstances when 
no other kind of animal food can be taken in sufficient 
quantity to furnish the tissues with a proper amount of 
fatty material. Its effects in phthisis are to nourish the 
body, which increases in bulk and in vigor, to check the 
exudation of tubercular matter and to diminish the cough, 
expectoration and perspiration. The common dose for 
an adult is a common tablespoonful three times a day, 
which may often be increased to four or even six to ad- 
vantage. When the stomach is irritable the dose to 
commence with is a teaspoonful. 

With regard to diet, it may be said in general terms, 
that one of a nutritious kind, consisting of a good pro- 



AND GUIDE TO HEALTH. 523 

portion of animal food, abounding in fat, is best adapted 
for phthisical. cases, whilst everything that induces acid- 
ity must be avoided. If possible, the patient should be 
sent to some healthy location and pleasant climate. 
Every care must be bestowed upon the appetite and di- 
gestive organs. Unless a person can take and digest 
cod liver oil at least in considerable quantities there can 
be no hope for his recovery. The habit of continually 
taking some expectorant, as squills, etc., for the cough, 
or even opiates, is injurious. The stomach must not be 
burthened with such drugs ; if it is there can be no hope 
that an appetite and digestion can be preserved. A lit- 
tle spirits of ammonia or infusion of Colombo or gentian 
may be used to give tone to the stomach. Good rye 
whisky may also be used, if it seem to agree with the 
stomach. Good fat beef tea should be used, and cream 
and butter, if they agree with the stomach. 

It is worse than folly to pour drugs down a patient to 
combat all the disagreeable symptoms that are sure to be 
present in consumption — almost any of them that arise, 
such as diarrhea, debility, sweating, vomiting, etc. The 
vomiting may be best treated by lime-water and milk — 
lime-water one part and milk three parts. The other 
symptoms can be best met by the use of cod liver oil 
and a judicious course of feeding. If there be febrile 
symptoms a light sponge bath will be useful, but this 
must not be administered so as to cause a chilly sensa- 
tion. 

Again I wish to repeat that the disease is caused by a 
system of improper or deficient nutrition, and the symp- 
toms must be met by a course of good nutritious feeding, 
at the head of which stands cod liver oil. Beef marrow 
is also good, in connection with butter, cream, beefsteak, 
ale, whisky, sherry wine whipped with egg and sugar, 



524 THE FAMILY PHYSICIAN 

etc., etc. I will also repeat again that it is not well to 
cram the stomach with drugs, as is the custom of some, 
for it impairs digestion. Good nursing, careful feeding, 
and perseverance in the use of cod liver oil will often 
enable nature, by a process of her own, to heal the lung. 
Always remember that you have a powerful ally in na- 
ture to cure even consumption, if you do your part by 
sustaining the system with fats. 



SCROFULA. 



This is a very common disease, manifesting itself 
under many forms, such as hip disease, white swelling, 
rickets, bronchocele, glandular enlargements, &c. The 
glands inflame and suppurate, forming ulcers, which dis- 
charge a white, curdy matter, and are troublesome and 
hard to heal. The disease is a tubercular one, the path- 
ology of which I have not sufficient space to enter into. 

SYMPTOMS. 

Scrofula generally exhibits itself first in the enlarge- 
ment of some of the lymphatic glands, particularly those 
of the neck. The tumors may remain in an enlarged but 
indolent condition for some time, causing little or no pain; 
but generally the swelling gradually advances, becomes 
painful, softens, and then discharges a thin, ichorous 
matter, mixed with curdy or cheese -like flakes. At first 
this matter is discharged from several small openings, 
but eventually they all combine and form an ulcer with 



AND GUIDE TO HEALTH. 525 

uneven edges. They are apt to be succeeded by other 
tumors, which run a similar course ; and the disease may 
continue in this manner for a number of years, until it is 
cured or the system is destroyed by it. 

CAUSE. 

The cause of scrofula is about the same as that of con- 
sumption (want of nutrition). The reader is referred to 
the article on that disease. 

TEEATMENT. 

For the treatment of scrofula iodide of potassium must 
be freely used. A good preparation is — iodide of potas- 
sium, two drachms ; syrup of stillingia compound, four 
ounces ; or, if the stillingia can not be had, syrup of sar- 
saparilla will answer. Of either of these preparations 
give a large teaspoonful three times a day. The stomach 
and bowels must be carefully attended to. Light, nu- 
tritious food must be used, and used freely, but in quan- 
tities that can be properly digested. Animal food, such 
as good fat beef and mutton, must be used, with good 
fresh butter and sweet cream. In connection with this, 
cod liver oil must be used in moderate doses two or three 
times a day. 

The skin must be carefully attended to by the use of 
the sponge bath. The general health must be promoted 
by every means possible, and the treatment long perse- 
vered in. The ulcers may be treated as other ulcers. 

The syrup of iodide of iron is an excellent remedy, 
and it would be well if its use was alternated with the 
iodide of potassium. 



526 THE FAMILY PHYSICIAN 



THE EYE. 



Before attempting to speak of the different diseases of 
this useful, but very delicate organ it will be necessary 
to give an explanation of the names by which different 
parts of it — or at least the most of them — are known. 
This will become more apparently necessary when it is 
understood that each of these different parts of the organ 
is obnoxious to diseases separate and apart from each 
other, and requiring different treatment. I can not, of 
course, give a regular systematic anatomy of the eye ; 
nor will it be necessary, for practical purposes, to even 
refer to all its parts. 

DESCRIPTION OF THE EYE. 

Several thin pieces of bone form the cavity or socket. 
The eye is shaped much like a pear, with its large end 
turned outward. The eye has been described as a ball 
or bag which contains a clear, thick liquid, somewhat 
similar to the white of an egg. The coats of the eye, 
says an old writer, answer to the brass tubes in a spy- 
glass ; one is fitted within the other like a nest of boxes. 
There are three principal coats, the external one of which 
is called conjunctiva. The outside of the eye is called 
the sclorotic coat, which is a thin, white membrane ; it is 
strong, firm, and dense as leather ; we call it the " white 
of the eye." There is an opening in the centre, where 



AND GUIDE TO HEALTH. 527 

the cornea is set ; it is placed here much like the crystal 
of a watch, and is clear or transparent. The cornea is 
very hard and firm. Beneath the cornea is the choroid 
coat, which is the medium for the blood vessels. Beneath 
this is the pigmentum nigrum, called Hack paint, which 
it resembles. Next is the iris, being the colored circle 
which surrounds the pupil of the eye, and is hung before 
the crystalline lens. The iris divides the liquids or 
humors into two parts — the one before the iris is called 
aqueous, and the part back of the iris vitreous. The 
crystalline lens is a small body, convex on both sides, 
transparent but more dense, lies directly back of the 
iris, and swims as it were in liquid. 

The rays of light enter through the crystalline lens, the 
impression is made on the retina, at the back inner part 
of the eye, and is conveyed to the brain by the optic 
nerve, the expansion of which, on the back part of the 
eye, forms the retina. The membrane or lining of the 
eyelids is called their conjunctival surfaces. 

CATARRHAL OPHTHALMIA. 

In catarrhal ophthalmia the conjunctiva, or white of the 
eye, becomes swelled and of a red color. It is usually 
considered the type of conjunctival inflammation, and 
may be excited by other causes than that of atmospheric 
influence, such as injury of any kind. 

SYMPTOMS. 

The eyelids are somewhat red and swollen, especially 
about their edges. The redness is more intense in the 
lower lid toward the palpebral sinus ; it is also thick and 
velvety looking. The upper lid may be so much swollen 
that it overlaps the lower one. The cornea may remain 
quite clear. 



528 THE FAMILY PHYSICIAN 

There is at first watering of the eye, the result, partly, 
of the serous exudation from the conjunctiva ; "but soon 
a puro-muculent discharge takes place. The matter ac- 
cumulates in greater or less quantity at the inner corner 
of the eye, and in flakes in the palpebral sinuses. Films 
of this matter get over the cornea and occasion transi- 
tory dimness of vision. A flood of tears occasionally 
takes place. Itching and smarting is felt at the corners 
of the eyes, heat, and a sensation as if there was a foreign 
body in the eye — sand, or something of the kind. 

In this form the light does not hurt the eye much. The 
eyelids feel stiff, heavy and tense. There is generally 
pain across the forehead and in the temples. 

CAUSES. 

This form may be excited by injury, but is generally 
excited by atmospheric influences. In this case it may 
occur epidemically. Under these circumstances it is 
usually of a very severe form, partaking more of the 
character of Egyptian ophthalmia in its milder degree — 
like which also it appears to spread by contagion. 
Generally both eyes are affected. 

TEEATMENT. 

The patient must be confined to a room a little dark- 
ened, take entire rest, use an easily digested and nutri- 
tious diet, and his bowels must be kept regularly open, 
at least once a day, by the use of saline cathartics. His 
skin must be kept moist by the use of Dover's powders, 
in from six to ten grain doses, two or three times a day ; 
and also the spirit vapor or sponge bath once a day. This 
will complete his constitutional treatment, with the ex- 
ception of tonics, which he must not neglect to use daily, 



AND GUIDE TO HEALTH. 529 

and of which quinine is preferable. If the patient is 
feeble he should have good wine. 

Cold water may be applied to the eye at first, but soon 
it will be found that tepid applications will be the most 
agreeable and of the most benefit. This may be done 
by wringing a cloth out of warm water and placing it on 
the eye, changing it as often as it seems to cool. A solu- 
tion of the nitrate of silver — from two to ten grains to the 
ounce — may be carefully dropped (three or four drops at 
a time) into the eye. This should always be done by some 
one who will take pains to raise the eyelids and work 
it about a little to insure the lotion to get well over the 
whole surface. A preparation of about four grains to 
an ounce of rain water will generally be strong enough... 
To apply it the patient's head should be laid back and 
the nurse drop three or four drops into the eye, and thea 
take hold of the upper lid with his finger and thumb and 
raise it from the ball, so that the water can run all over 
the whole surface. This may be done twice a day. At 
night the edge of the lids may be wet with cold-pressed 
castor oil. The patient's feet should be often bathed 
with warm water, and he should have enough Dover's 
powders at night to make him sleep. The head and 
shoulders should be somewhat elevated. It is always 
well in the commencement to examine and see if there is 
any foreign substance in the eye, and if so, remove it. 

PURULENT OPTHALMIA. 

This is a form characterized by a discharge of purulent 
matter, redness of the eye, etc. 

SYMPTOMS. 

The first symptom felt,, generally, is a sensation of 

itching, as if there were sand or particles of dirt in the 
34 



530 THE FAMILY PHYSICIAN 

eye. The eye becomes very red and the conjunctiva 
swells so as to give the cornea the appearance of an in- 
dentation. The eyelids swell and are almost immov- 
able, the discharge is profuse and of a yellowish color. 
The inflammatory symptoms vary from a mild character 
to one of great violence, "being accompanied with a sharp, 
lancinating pain, situated deep in the eye-ball. The dis- 
ease may terminate in bursting of the cornea, abscess of 
the cornea, ulceration of the cornea, opacity of the cor- 
nea, thickening or granulation of the lids, &c, &c. This 
form may be distinguished from catarrhal by the profuse 
discharge of matter. 

CAUSES. 

This form may be produced by injury or the atmos- 
phere, but it is certainly communicated by contagion, 
and prevails some seasons, it would seem, epidemically. 

TREATMENT. 

The constitutional treatment for purulent ophthalmia 
must be the same as that recommended for catarrhal. 
Cold applications to the eye are apt to prove more ser- 
viceable in this form, particularly at first. For this pur- 
pose if a steady, small stream can be applied for ten or 
fifteen minutes at a time usually much benefit will be 
derived from it. A useful application in this form may 
be made by taking tannin three grains, morphine two 
grains, slippery elm bark water one ounce, and three 
grains .of sulphate of zinc ; mix and dissolve. Of this 
preparation drop in three or four drops three times a 
day, in the manner directed for the nitrate of silver in 
catarrhal ophthalmia. The solution of nitrate of silver 
sometimes has a splendid influence in this disease, curing 
bad looking eyes in a remarkably short time. It should 
be used five or six grains to the ounce. After the disease 



AND GUIDE TO HEALTH. 531 

has progressed the applications must be warm — they 
may be of water or the bread and milk ponltice. The diet 
may be generous and plenty of wine allowed. Bleeding, 
leeching, cupping, scarrifying, mercury and antimony 
must not be resorted to. Many other forms of disease 
will often arise in which different parts of the eye are 
affected. The constitutional treatment will be about 
the same, unless they are complicated with or dependent 
upon other diseases, in which case the disease must re- 
ceive the first attention. Many forms of disease of the 
eye will require surgical operations, in which case I take 
pleasure in recommending my friend Dr. William Me- 
haus as an oculist eminently qualified to treat any of the 
diseases of the eye, and whose name has already gone 
forth as one among the best operative surgeons in this 
country. His office is on the corner of Eighth and Pine 
streets, St. Louis, Mo. 



DISEASES OE THE SKIN. 



HERPES 



The name salt rheum or tetter is applied to several 
diseases of the skin. This is characterized by irregular, 
elevated patches of inflammation of the skin, covered 
with thin, irregular white scales. There is some itching 
and pricking attending the disease. The hands are the 
parts most generally attacked, and the skin is often di- 
vided by deep fissures. 



532 THE FAMILY PHYSICIAN 

TEEATMENT. 

This disease often requires constitutional treatment, 
such as syrup of stillingia compound, four ounces ; iodide 
of potassium, two drachms — to be taken one teaspoonful 
three times a day. The spirit vapor bath will be useful. 
Stramonium ointment may be used for an external dress- 
sing, and a wash may sometimes be used of a solution 
of oxalic acid. 

SHINGLES. 

This disease is characterized by irregular patches of 
various sizes and of a red color, covered with clustered 
vesicles, forming a half-belt on the body extending to the 
middle line. 

TEEATMENT. 

Shingles generally disappear under very simple treat- 
ment. The bowels should be regulated and iodide of pot- 
assium given in full doses. The spirit vapor bath may 
be directed, the diet light and nutritious. 

RINGWORM— HERPES CIRCINNATUS. 

This disease is characterized by patches of inflamed 
skin forming a circular ring of small size, from the size 
of a pea to that of a fifty-cent piece. It may attack any 
part of the body. 

TEEATMENT. 

If the parts be very irritable and much inflamed a 
poultice of flax seed meal will be necessary, after which 
a solution of oxalic acid, ten grains to an ounce of water, 
may be applied. The skin must be attended to by means 
of the spirit vapor bath. The bowels must be kept reg- 
ular. 



AND GUIDE TO HEALTH. 533 

SCALD HEAD— TINEA CAPITIS. 

This is a disease of the scalp, and is characterized by 
minute pale yellow pustules around the roots of the hair 
and in various situations on the scalp. These pustules 
increase in size and number and are surrounded with an 
inflammatory blush and accompanied with intense itch- 
ing. Crusts or scabs are soon formed, which increase in 
size and are very firmly attached to the skin. Sometimes 
the whole scalp becomes involved and presents the ap- 
pearance of a solid scab. 

TREATMENT. 

The hair must be cut as close as possible, and a poul- 
tice of flax seed meal mixed with a solution of subcar- 
bonate of soda applied, after having first carefully washed 
the whole scalp with castile soapsuds, tepid or warm. 
After the poultice has remained all night remove it and 
wash the scalp clean, and if there seems to be little or 
no inflammation, apply a weak solution of oxalic acid, 
one grain to an ounce of water, at first. If this does not 
produce pain or irritability increase it until it is of ten 
times that strength ; apply this through the day and 
poultice as above directed at night — both to lessen the 
inflammation and remove the scab. A drop of creosote 
may finally be added to each ounce of the solution of 
oxalic acid. It requires considerable time to cure this 
disease. 

ITCH, OR PSORA. 

This is a simple contagious disease of the skin, too 
well known to need a description here. 

TREATMENT. 

The custom has been to treat this eruption with sul- 
phur or mercurial ointment. This is unnecessary, as the 



534 THE FAMILY PHYSICIAN 

oil that is in the above articles is quite enough to destroy 
it. Simply wash the skin clean with castile soapsuds 
and anoint it well with lard. Eepeat this for a few 
weeks and nothing more will be necessary. 



WORMS. 



"Worms are found," observes Dr. John King, "in all 
animals and in various parts of them. In man they have 
been met with in the kidneys, liver, eye, lungs, brain, &c; 
but those which are more frequently met with infest the 
intestinal canal. 1. The tricocepalus dispar, or long 
thread worm, which is a round, white worm about one or 
two inches in length and occupies the large intestines. 
2. The Oxyuras vermicularis, maw or thread worm, 
usually called ascaris. It is a small, thin, white worm, 
not exceeding an inch in length, with a pointed tail, and 
chiefly lodges in the rectum, where it gives rise to much 
itching and uneasiness. These worms are very common 
to children, though adults may have them. 3. The 
ascaris lumbricoides or long, round worm, which is a 
round worm varying from three to twelve inches in length 
and from the twelfth to the sixth of an inch in diameter ; 
its color varies according to that of the food, being fre- 
quently milky or of a brown- ash and occasionally blood- 
red. It is more commonly found in the small intestines. 
4. The taenia solium, or long tape worm, is a flat, articu- 
lated or jointed worm, with four suckers at its head, of a 
white color, and varying in length from a few feet to sev- 
eral hundred. It inhabits the small intestines." 



AND GUIDE TO HEALTH. 535 

With regard to the origin of this singular worm (the 
tape worm), it has been pretty well ascertained that it is 
only further stages of development of cysticeri. Now, 
this cysticeri is a genus of worms of the family of the 
hydatids. To explain further, hydatids are vesicles softer 
than the tissue of membranes, more or less transparent, 
which are developed in organs, but without adhering to 
their tissue. Man feeds on animals in which those cysti- 
ceri are common, especially on the pig, sheep and rabbit ; 
and it has been observed in countries where meat is often 
eaten raw, as in Abyssinia, tape worms are very com- 
mon. Each joint of the tape worm is estimated to con- 
tain 125,000 ova ; these minute bodies pass off by the 
feces in incalculable numbers. These ova will produce 
the worm. Dr. Kuchenmaster fed dogs and cats upon 
parts of animals which contained different kinds of cys- 
ticeri, and subsequently found the tape worms into which 
these had been transformed in various stages of develop- 
ment, according as the life of the animal that had eaten 
the cysticeri had been more or less prolonged afterward. 

Dr. Bennett observes that " numerous cases have oc- 
curred, especially in India, where men encamped on the 
borders of a lake have subsequently been attacked by 
tape worm, evidently in consequence of the water they 
consumed containing the ova of the worm. The parasite 
also has been known to infest Hindoos who had eaten 
no flesh. There can be little doubt, therefore, that the 
numerous ova of tape worms voided by animals may 
enter the intestines of a man with the food or drink and 
then be transformed into taenia (tape worm)." 

This direct mode of entry must not be overlooked while 
investigating the undoubted origin of the worm from its 
cystic or hydatid stage of transformation in the tissues 
of other animals. 



536 THE FAMILY PHYSICIAN 

Dr. Fleming considers that the frequency of measly 
pork in Ireland is due to the pig being reared in the 
peasant's cabin, where it commonly has a dog for its 
companion, which animal is almost always infested with 
tape worm and must void a multitude of ova that find 
ready access to the aliment of the other. Experience 
shows that the measle is generated in the muscle of the 
pig by feeding it with ripe joints of the dog's tape worm, 
now considered to be the same as the tape worm found 
in the human, and that the same tape worm is developed 
in the intestines of a dog fed with fresh measly pork. 
The measle is not generated in the dog by feeding it with 
the tape worm eggs. Why, in some animals, these ova 
are fully developed in tape worm in the intestines, whilst 
in others they enter the blood and are transformed only 
into cystic worms (hydatids) in the liver, brain or other 
organs, is probably owing to the peculiarities of struc- 
ture, which have not been yet investigated. 

TAPE WOEM. 

The presence of tape worm may be known by a gnaw- 
ing pain in the stomach, irregular appetite, but generally 
voracious ; and the food eaten does not nourish the sys- 
tem, as evidenced by great emaciation. There is a hard 
cough, with considerable mucous expectoration, great 
thirst at times, debility, and small bodies in the excre- 
ments of the worm resembling cucumber or melon seeds. 
Sometimes a few joints of the worm may be expelled at 
stool. 

TEEATMENT. 

There is a very great number of remedies proposed for 
the expulsion of the tape-worm. Dr. King says that 
the " Entozoic Powder " has been used by him for many 



AND GUIDE TO HEALTH. 537 

years and it has never disappointed him in any one in- 
stance. He also says : " It is probably unsurpassed in 
removing any kind of worms which may exist in the hu- 
man intestines." He says, " it is very hitter and disa- 
greeable to the taste, but it may be relied on as certain 
in destroying and removing worms, whether in adults or 
children. It acts by not only destroying the worms them- 
selves, but likewise removes that slimy substance in 
which they abound, and which is so favorable to their 
production." 

This " Entozoic Powder " is made by taking white In- 
dian hemp root, mandrake, pinkroot — of each, in pow- 
der, one ounce ; balmony, in powder, two ounces ; soco- 
trine aloes, in powder, four scruples : mix thoroughly to- 
gether. 

For a child one year old, place a teaspoonful of the 
powder in a gill of molasses and give a teaspoonful of 
the mixture every one or two hours, until it operates 
freely ; after which give a teaspoonful three times a day 
for several days in succession, or less if it purge too 
freely. An adult may take half a tablespoonful every 
hour. — J. King's Pharmacy, page 739. 

Dr. Bennett observes, " Of all the vermifuge remedies 
proposed for the expulsion of tape worm, I have found 
the ethereal extract of the male shield fern the most 
effectual — a preparation first proposed by Peschier, of 
Geneva, and since strongly recommended by Dr. Chris- 
tison. That it readily dislodges large masses of the 
parasite has been witnessed by all who have tried it, al- 
though it has not succeeded in every instance in perma- 
nently destroying or removing the animal. This, how- 
ever, appears to me in a great part, if not wholly, ac- 
counted for by the circumstance that patients on being 
dismissed return to the same kind of food from which 



538 THE FAMILY PHYSICIAN 

they originally received the ova of these woftns. This is 
very likely to be the case in certain English comities, 
where Tbacon and other preparations of pork are common 
articles of diet among the people." 

Dr. Bennett administered the ethereal extract of the 
male shield fern to Catherine Watt (aged 25) ; on the 
first evening two scruples, followed the next morning 
"by one ounce of castor oil. This caused the evacuation 
of seven joints of the worm. Another dose of one scru- 
ple was followed at night, and one ounce of castor oil 
next morning. On its action only three joints of the 
worm passed. Ordered again at night half a drachm 
of the extract. Next morning, after taking the ounce 
dose of castor oil, she passed many separate joints and 
several long portions of the worm. The whole together, 
when measured, was calculated to Ibe about fifteen yards 
long. One portion, the Doctor remarks, was evidently 
formed of the joints of the worm near the head, as they 
were broader than they were long, and above the tenth of 
an inch in length. This was on November 23d. She re- 
mained in the house until the 6th of December, and al- 
though she took the medicine four more times no more 
joints of the worm came away. 

Kamala is another medicine that stands high in the 
scale for the treatment of tape worms, but certainly the 
male shield fern extract is preferable to all others. 

SYMPTOMS OF WORMS. 

The symptoms of the presence of worms are- very 
equivocal, with the exception of the maw or thread worm, 
which may be known by the annoying and almost in- 
tolerable itching which they occasion within the anus, 
and by their frequently being seen in considerahle num- 
bers in the fceces. 



AND GUIDE TO HEALTH. 539 

In children a paleness of the countenance, itching of 
the nose, starting and grinding of the teeth during sleep, 
irregular appetite, a foetid breath, hard swelled belly, 
upper lip considerably swollen, sore month at times, 
picking of the nose, one of the cheeks more or less con- 
stantly flushed, with more or less fever, may be con- 
sidered certain evidences of worms As to the color of 
the tongue it is rather uncertain ; but on a close examin- 
ation quite a number of small, round, raised, red papillae 
may be noticed. Worms frequently cause children to 
have convulsions. 

TKEATMENT. 

The Entozoic Powder so highly recommended by King 
will be found useful in cases where the child can and will 
take it, but it is very bitter, and is often vomited by 
children. A simple and often efficacious remedy is oil 
of wormseed (Jerusalem oak), from three to six drops on 
a lump of sugar morning and evening for five or six days, 
and then a full dose of oil. This for a child one or two 
years old ; to one five or six, eight drops may be given. 
"Wormseed pulverized and mixed with molasses is a 
popular remedy. 

Pink root (Spigelia Marilandica) is an old time 
remedy, and thousands can testify to its efficacy. It may 
be given in powder, in doses of live to ten grains, to a 
child two or three years old, or an ounce of the strong 
infusion two or three times a day for a few days. It 
must not be given in too large doses, as it is narcotic. It 
may be given to an adult in two drachm doses, twice a 
day for several days, and then followed by a large dose 
of castor oil. 

The thread worms are sometimes hard to remove from 
the rectum. Bitter injections, however, will seldom fail 



540 THE FAMILY PHYSICIAN 

to bring them away in a few days : Take balmony, one 
ounce ; mandrake (may-apple root), half an ounce ; 
water, one pint. Mix, and Tboil to form a pint of strong 
decoction, to which add a gill of molasses, a teaspoonful 
of salt, five grains of quinine, and an ounce of tincture of 
assafcetida. Use this as an injection, half a gill at a 
time, three times a day for several days. 

Children often troubled with choking or swallowing, 
from worms apparently coming up in their throat, may 
be relieved by drinking a little salt water. 

Children after discharging their worms should use a 
tonic and good diet. Tincture of Colombo in small doses 
is an excellent tonic for the stomach and bowels. 



CROUP. 

CYNAISTCHE TRACHEALIS. 



Croup is a disease which is characterized by inflam- 
mation of the throat and windpipe in children, com- 
mencing in the air passages and extending sometimes 
into the bronchi. It causes thickening of the mucous 
membrane and an altered secretion, which may become 
either membraniform or purulent. There is a frequent, 
sharp, harsh, ringing cough; difficult breathing, with 
loud, shrill inspiratory sound; altered voice, at first 
hoarse, afterward whispering or extinct; fever, thirst, 
loss of appetite, but little or no difficulty in swallowing. 
Croup is specially a disease of childhood, occurring 
most frequently from the first to the seventh year, as 



AND GUIDE TO HEALTH- 541 

statistics and observations show. In one hundred deaths 
from croup we may estimate 13 as occurring in the first 
year of life, 25 in the second, 22 in the third, 16 in the 
fourth, 11 in the fifth, and 13 above that age. 

SYMPTOMS. 

The first indication is often mere hoarseness in the 
tone of voice or cry, the child is feverish and either dull 
or fretful ; is thirsty and drinks without difficulty ; the 
tongue has a white fur and is red at the tip and edges. 
There is some heat and dryness of the skin, and a check 
to the ' secretions generally. An occasional short, dry 
cough may be noticed, which seems to give a pecu- 
liar, hoarse, hollow sound — a sound once heard, not 
likely to be forgotten or mistaken for any other. How 
readily, and in what pain and solicitude, the mother's 
quick ear detects that unwelcome sound ! It augurs ill 
for her child. A little harshness may be detected in the 
child's breathing. The more characteristic symptoms 
generally come on at night. During the first sleep the 
cough is noticed to be sharp and harsh, with that peculiar 
croupy clang we have just spoken of, which is always 
easily recognized. This may be repeated at some inter- 
vals without arousing the child from sleep. The heat and 
dryness of the skin are now more marked, the pulse is fre- 
quent and strong, and the breathing loud and difficult, 
when some repeated clanging cough, with shrill drawn 
breath, awakes the child in a fright, struggling for breath. 
He starts up, is flushed and hot, the eyes glaring and 
red, a hissing sound accompanies every inspiration, and is 
very marked and loud after the short, dry, croupy-sound- 
ing cough. It is evident that insufficient air enters the 
chest, although the respiratory efforts are great. The cir- 
culation is now also highly excited, the face turgid, the 



542 THE FAMILY PHYSICIAN 

color deepens, the child puts its hand to its throat as if 
to remove obstruction ; speech becomes impossible, and 
soon, as if in despair, muscular effort relaxes and air be- 
gins to enter the chest more freely. 

The paroxysm may come on within a few hours of ex- 
posure, and sometimes, though rarely, before the usual 
symptoms of ingress have been noticed. It may begin 
at any hour, but occurs most frequently at night, and is 
seldom delayed beyond thirty-six hours from the com- 
mencement of the illness. It may last but a few min- 
utes, or be prolonged, with varying intensity for more 
than an hour. Its first accession is nearly always fol- 
lowed by a remission more or less complete, sometimes 
so perfect that the most careful examination is required 
to ascertain the presence of the disease. The most val- 
uable indication of the presence of the disease, even at 
this early period, is drawn from the respiratory sounds 
and movements. The voice may attract attention — the 
cough will soon give the trumpet-note of alarm. 

The disease attains its hight by the end of the third 
day at the latest, but the intensity of the attack may 
hasten the stages of its advance, and death may occur 
within forty-eight hours, or less, from its commencement. 
The characteristics of this second period are, high vas- 
cular excitement and an ever-increasing difficulty of 
breathing. The cough is now almost incessant, or fre- 
quently recurring in shocks of convulsive violence. 

The third stage is that of apncea, or failure of breathing, 
and rapid advancing exhaustion. It may come on in the 
manner just described, but more frequently is the direct 
sequence of more urgent symptoms of the second stage, 
which, when about to lead to this result, present some 
noteworthy particulars. The voice is whispering, or 
completely suppressed ; the cough stifled, powerless, or 



AND GUIDE TO HEALTH. 543 

altogether absent;- the head is thrown back, the lower 
jaw fixed, the month partly open, and the face livid ; the 
pulse becomes either too weak or too rapid to be connted, 
the temperature falls, and the perspiration becomes cold 
and clammy ; the features become pale and set, the eyes 
lose their expression, and become distorted and fixed. 
Need I say that dissolution is nigh, and another sweet 
bnd of promise is about to be wrung, by the inexorable 
demand of the enemy, death, from a mother's broken, 
bleeding heart. 

I have been thus particular and minute in giving the 
prominent symptoms of croup, that each mother may 
detect its presence the moment it attacks the child, for 
early treatment is important. One of the objects of this 
work is to furnish the advantages of early treatment of 
such diseases as croup, where delay is almost certain 
death. The child is attacked with croup, the night per- 
chance is dark and stormy, the family physician is miles 
away — what is to be done ? The mother is ignorant as 
regards this dangerous disease and its treatment ; long 
before the doctor can be summoned and reach the little 
sufferer his feeble constitution must succumb to the vio- 
lence of the disease. With these facts staring her full 
in the face, and her sweet, dying babe before her, what 
would she not give for the knowledge that would enable 
her to disarm that disease of its terror and rescue that 
lovely child — the pride, solace and joy of her heart — from 
a premature death. And O ! with what bitter anguish 
would she always afterward accuse herself if that child 
should die from an ignorance on her part that is wholly 
inexcusable. With the symptoms and treatment of this 
disease written out plainly, and the book within her easy 

reach, can she do less than accuse herself of ' — ! 

Let her broken heart and guilty conscience answer. I 



544 THE FAMILY PHYSICIAN 

would not open afresh her wounds by writing the blight- 
ing word that will ever be upon her lips. ISTo ; I leave 
her to her silent, withering anguish, like Rachel, weep- 
ing for her children and refusing to be comforted because 
they are not. 

But before this sad scene is enacted, and your dear 
child is laid low in its narrow little grave, acquaint your- 
self with this dangerous disease ; and when it has laid 
its bloody hands upon your tender babe, meet it with 
full confidence. By proper medication, nineteen times 
out of twenty ; you will succeed in saving the life of your 
child. This result can only be attained by prompt ac- 
tion, and a knowledge of the disease and its treatment. 
This knowledge can only be had by studying it as it has 
been written by some one of experience. 

TEEATME15TT. 

The induction of vomiting in the early stage is the 
most effective means of arrest, and one that must be re- 
sorted to in all stages of the disease but the last. For 
this there is nothing better than twelve grains of ipecac, 
powdered, to a drachm (teaspoonful) of syrup and three 
drachms of water ; take also one grain of antimony and 
one teaspoonful of hot water, dissolve the antimony in 
the water and add this to the other preparation (ipecac, 
syrup and water), and give to a child from two to four 
years old half of the preparation, and if it does not pro- 
duce vomiting in half an hour give the remainder. The 
room must be kept at a temperature a little elevated, not 
too hot, however, and aqueous vapor diffused therein. 
An easy and effectual way to do this is to pour water on 
rocks or bricks hot enough to give off a steam, which 
should be frequently repeated. Water enough should 
be warmed for a bath, and when the symptoms seem 



AND GUIDE TO HEALTH. 545 

violent the child's body and limbs shonld be immersed 
in it, after which a warm poultice of roasted onions, made 
by roasting abont two onions ; brnise them or beat them 
fine, place them in a vessel, add a pint of hot water to 
them and let them come to a boil, then add or stir in half 
a pint of corn meal ; when this has become of the proper 
consistence spread a poultice of it on a cloth and apply 
it warm to the child's breast and the lower part of the 
neck. This should be changed occasionally. This I 
prefer to any other application. A hop fomentation will, 
however, answer. In the absence of either, cloths wrung 
ont of hot water and applied frequently to the breast and 
neck will answer. After the action of the emetic and the 
bath has been had the patient will feel much easier. It 
will be necessary then to give abont two grains of calo- 
mel to have an aperient effect on the bowels. This may 
be aided, in eight or nine honrs, by a dose of castor oil. 
The patient should take four or five grains of chlorate of 
potash three times a day, well diluted in water. If there 
be persistence of febrile symptoms, of the cough, or of 
any laryngeal quality in the breathing, half teaspoonful 
doses of antimonial wine must be given with each dose 
of the potash, or a smaller dose at more frequent periods, 
taking care to give it less frequently as the symptoms 
subside, and stopping altogether as soon as relief is ob- 
tained. The emetic preparation must be kept at hand, 
so that in cases of threatened paroxysm its full effects 
may be again induced. It is to be borne in mind that 
the paroxysm has a tendency to recur even when the dis- 
ease is not advancing, and that the recourse to the warm 
baths may afford such relief as to enable the air to be 
drawn in again, either with freedom or with lessening 
signs of obstruction. The attack, when treated early, is 

not unfrequently arrested ; the patient requires to be 
35 



546 THE FAMILY PHYSICIAN 

carefully watched, that any return of the croupy symp- 
toms may receive timely attention. However favorable 
the progress, the child should Ibe confined to bed for two 
or three days, the diet being gradually increased. Dur- 
the first part of the attack cold water is all that should 
be allowed the child (except the medicine) ; but later in 
the disease, if it is a protracted case, beef tea or chicken 
broth must be given. Calomel should be given from the 
first and repeated frequently in small doses, interrupted 
occasionally for the repetition of the emetic. A grain of 
calomel combined with one-fourth or one-eighth of a grain 
of ipecac every two hours ; if the bowels becomes dis- 
turbed the quantities must be lessened ; this, however, 
must not be pushed to " salivation." 

The principle is : first an emetic ; then a warm bath, 
poultice or fomentation to the breast and neck, aperient 
of two grains of calomel, and eight hours after castor oil ; 
then to excite the secretions by small doses of calomel, 
and produce a little nausea by the use of antimony or 
ipecac, or both; then a nourishing diet. Repeat the 
emetics and bath as often as necessary to relieve violent 
symptoms. 

If a stimulant is necessary at any time, carbonate of 
ammonia will answer the purpose best. Lobelia in some 
of its forms is an excellent article, and may be used both 
as an emetic and nauseant ; but I prefer the ipecac and 
antimony, either of them having a better influence on the 
the skin. 

The disease is a formidable one, and has been fearfully 
destructive to life among children. The mother is not 
alarmed without good cause when it is announced to her 
that her child has " got the croup." The fatality that 
has attended the complaint is largely attributable to de- 
lay in the treatment ; almost every case will yield readily 



a:std guide to health. 547 

to proper treatment, if commenced in its incipiency ; but 
if allowed to proceed undisturbed, even for a short time, 
the danger is vastly increased. Every mother ought to 
have at her command such articles as are recommended 
for the treatment of this disease, and when the first 
prominent symptom presents itself be ready to treat it 
while the golden moments last ; delay is dangerous. 

Tracheotomy has sometimes been successfully per- 
formed in this disease, when suffocation has been about 
to take place from the thickened condition of the mem- 
brane ; but this is an operation that would require a 
surgeon, proper instruments, tubes, etc. I would not 
recommend any but an experienced hand to undertake 
it. In fact, if the directions given in the preceding pages 
be promptly followed there will be no necessity for such, 
extreme measures. If a physician is called to a case in, 
an advanced stage, and finds the child in a suffocating; 
condition, no circumstance of age or condition should 1 
prevent him from giving the child this one more chance 
for life. Both in this disease and laryngitis hundreds of 
lives have been saved in that way that could not have 
been saved in any other. 

A popular treatment of croup has been the application 
of nitrate of silver in solution, varying in strength from 
a grain to half a drachm to the ounce of water. That 
this treatment has proved beneficial I have no doubt, but 
that it is inferior to the course above recommended is 
certainly apparent to any medical man who will take 
into consideration the nature of the disease ; but used in 
some cases of membranous croup, in connection with the 
treatment above, it will prove of great service. The solu- 
tion should be about three grains to the ounce of water. . 



548 THE FAMILY PHYSICIAN 



HYSTERIA-HYSTERICS. 



Hysteria is a disorder of the nerves common to females, 
but sometimes met with in males. It is a spasmodic 
affection of more or less intensity, often assuming the 
most varied forms, and assimilating to almost every dis- 
ease known to man. The attacks usually commence 
with a now of clear urine, uneasiness and irregular mo- 
tions and rumbling noises in the left side of the abdomen, 
or the sensation of a ball rising upward to the throat. 
This is termed globus hystericus. This symptom is at- 
tended generally with a feeling of suffocation, and some- 
times convulsions. 

The disease affects principally females of great nervous 
sensibility and of mental emotion. "Women from the age 
of sixteen to thirty-five, unmarried women, and young 
widows are most subject to this disease. 

SYMPTOMS. 

In noticing the symptoms, I shall consider the disease 
as it occurs in a paroxysm, as it affects sensibility, and 
as it mimics other diseases. Sometimes there is pain in 
the left side and abdomen, with a sense of fullness and 
rumbling, followed by the globus hystericus, or ball as- 
cending to the stomach and throat with a sense of suffo- 
cation, the patient complaining all the time that she feels 
" so tired." These symptoms are quickly followed by 
stupor, insensibility and convulsions, and sometimes 
laughing or crying without visible cause. 



AND GUIDE TO HEALTH. 549 

The convulsions consist of a movement of the trunk 
and linibs. There is often violent "beating of the breast 
with the clenched hands, or tearing of the hair or gar- 
ments, shrieks and screams, with violent agitation, end- 
ing in tears or convulsive fits of crying, and sometimes 
obstinate hiccough, are some of the varied symptoms 
that attend this eccentric disorder. The patient some- 
times sinks to the ground insensible and exhausted, re- 
mains so for a short time and then recovers, tired and 
crying. The attendant symptoms are great sensibility 
and irritability of mind, spirits elated, depressed or vari- 
able, independent of any visible occasion, with ridiculous 
fancies. The body is tossed to and fro ; wild, incoherent 
expressions are uttered ; with a continual complaint of 
feeling tired. " I am so tired," is an expression that will 
very frequently greet your ears while administering to 
the poor sufferer. There is no froth at the mouth, the 
tongue is never bitten, and the patient is always con- 
scious of what is going on around her, although she may 
be unable to speak or move. 

Hysteria differs in appearance from epilepsy by the 
breathing never being suspended, the tongue is never 
bitten and the attack is not followed by coma, as 
epilepsy is. The sensibility in various tissues seems to 
be much increased in some patients ; the fleshy part of 
the muscles are very liable to become so affected. The 
pain is generally aggravated by pressure, by movement 
and by moral emotion. It is relieved by resting the 
affected muscle. It varies in intensity from mere un- 
easiness to the most acute suffering, destroying all repose, 
producing fever and general disturbance, and is generally 
accompanied by weakness and mental depression. There 
is none of the heat, redness or pulsation of inflammation. 
This increased sensibility is called hyper CBstliesia. " The 



550 THE FAMILY PHYSICIAN 

opposite condition, ancestliesia or loss of sensibility, is a 
prominent phenomenon in some instances, and it is prob- 
able that nervous women and magnetic somnambulists, 
whose insensibility is supposed to be a trick, are often 
merely hysterical women thus affected." 

The diseases that hysterics simulate most are sup- 
pression of the urine, inflammation of the peritoneum, 
pleurisy, consumption, laryngitis, loss of voice, paralysis, 
and disease of liver and spine. Hence it is well to see 
that there are no hysterical symptoms present before 
treating one of these diseases. I have seen a lady treated 
for inflammation of the liver who only had hysteria, an- 
other for inflammation of the womb, and others for differ- 
ent diseases, who only had hysteria. The patient deceives 
herself and tries by strong expressions of suffering to 
mislead others. A practiced eye is, however, seldom 
imposed upon by hysterical patients. There is a peculiar 
expression about hysterical women impossible almost to 
define ; yet when it is once seen it is never forgotten, but 
readily recognized when seen again. There is a fullness 
of the upper lip, and a thickness, with a tendency to 
drooping, of the upper eyelids. Those two last symptoms, 
I believe, are always present, particularly about the time 
of, or during a paroxysm. They answer questions in an 
unpleasant manner, and their pains are always said to 
be most acute and to be increased by pressure, or by even 
pretended pressure. And here the important question 
may be asked : Are these pains and suffering feigned ? 
Certainly not. The belief is wide-spread among people 
who, it would seem, ought to know better, that in hys- 
terics the whole thing is feigned, and all manner of sport 
is made of a woman who has the great misfortune to have 
hysterics. To such I would say that it is as much a dis- 
ease as the chills, the pneumonia or rheumatism. Ask 



AND GUIDE TO HEALTH. 551 

one of these wise ladies if nervous headache is feigned 
with her and she will feel that you insult her intelligence 
and mock her sufferings. Well, this headache is only the 
effect of centric influence on the nerves, while hysteria 
is eccentric influence thrown back upon the muscular 
tissue, thereby causing convulsions, over which the poor 
sufferer has no more control than the former has over her 
headache, or any other disease she may have. 

TEEATMENT. 

The first thing to be done during an attack is to have the 
patient's clothing loosened, and she must be placed where 
she can have plenty of cool air, and smelling salts may be 
applied to her nose. She may then be given a teaspoonful 
of the compound tincture of valerian, or a teaspoonful of 
the spirits of lavender compound and a teaspoonful of 
Hoffman's anodyne, and apply cold water to the head. 
As soon as she can take it, a full dose of the citratized 
magnesia must be given. These patients will often take 
anything or do anything very readily, if you only tell 
them firmly that they have it to do and just proceed to 
administer it. If this or some other active cathartic can 
not be administered, give an injection — of castor oil two 
ounces, molasses one ounce and warm water three ounces ". 
This must be thrown well up into the bowels and retained 
as long as possible, and repeated as often as necessary 
to produce an evacuation of the bowels. If there be any 
uterine disease or irregularity — and nine times out of ten 
there will be — it must be treated. There is almost certain 
to be leucorrhea, suppression of the menses or some one of 
the diseases peculiar to women, present, and it will be 
found that but little good can be done for the patient 
while such disease exists. In all forms of hysteria the 
general health must be attended to — the bowels kept 



552 THE FAMILY PHYSICIAN 

freely open, the skin bathed, the diet prudent, being 
careful to select such articles of food as will be easy of 
digestion and nutritious. Coffee and tea must be forbid- 
den in hysteria. Some of the preparations of iron will 
be indicated in the treatment. The patient may occa- 
sionally take a teaspoonful of Hoffman's anodyne or 20 
drops of fluid extract of hyoscyamus at bed time to pro- 
mote sleep. Her mind should be given to pleasant and 
wholesome occupation. She should go much into pleasant 
company and if possible travel some. She will be rather 
inclined to seclusion, but this must not be allowed ; it will 
only increase her gloom and have a depressing influence 
on her nerves, which are already in a depraved condition. 
The cure of hysteria is sometimes tedious, but by perse- 
verance, with proper remedies and a well directed course 
of hygiene, all cases that are not dependent ujpon some 
incurable complication can be cured. Patients with 
hysteria, if left to their own choice, will not persevere in 
anything long enough to effect a cure. They need some 
kind hearted friend who will urge and even force them 
to persevere in taking their medicine, go into company, 
take proper exercise, bathe frequently, and attend to all 
things necessary to build up their shattered nervous 
system, &c. 

In addition to the course already suggested for the gen- 
eral treatment of hysteria when it is uncomplicated, there 
is a special treatment, or rather an article that may lay 
some claims to a specific, in that disease. I mean the 
great calmative and anti-spasmodic, Bromide oe Potas- 
sium. The influence of this article on spasm of any kind 
is just now being understood by the medical profession, 
and in hysteria as well as epilepsy, although these dis- 
eases differ materially, the bromide of potassium will 
exercise a greater power for good than perhaps any other 



AND GUIDE TO HEALTH. 553 

article. The dose is from three to ten grains, three times 
a day, but for hysteria one dose each day will be suffi- 
cient during the intervals, but on appearance of the 
approach of an attack it should be used more freely. It 
may be taken in water or made into pills. 



C0NSTIPAT10I OF THE BOWELS. 



By constipation or costiveness is meant a partial or 
complete retention of the feces, they being hard, dry, 
and in diminished quantity when passed, and voided with 
or by much straining and sometimes with much pain. It 
may occur as a constitutional condition, but is more fre- 
quently symptomatic of some disease or impropriety. 
It may generally be attributed to the latter cause, the 
impropriety generally consisting in improper diet and a 
neglect to attend to the calls of nature at the proper time. 
It often arises during pregnancy and is a troublesome 
disease through it. 

As a rule, most people have an evacuation every day, 
but some persons habitually go to stool twice in the 
twenty-four hours, while others only have an operation 
every second or third day. The most important conse- 
quences which result from habitual costiveness are irri- 
tation of the mucous membrane of the bowels and the 
reabsorption of excrementitious matters. The functions 
of the stomach, liver, pancreas, &c, are imperfectly per- 
formed, and hence complaint is made of a sense of op- 
pression, mental and bodily. The intellectual faculties 



554 THE FAMILY PHYSICIAN 

are dulled, tlie complexion becomes sallow, the skin dry, 
the urine scanty, and the stools become pale and clay- 
like and very offensive. 

TKEATMESTT. 

Pnrgative drags must not be relied npon to cure cos- % 
tiveness. They can not be done away with at one rude 
blow, but it is possible at once to substitute simple 
aperients for the various patent drugs, the mischievous 
blue pills and nauseous black draughts with which the 
public are in the habit of, and so fond of, tormenting 
their stomachs. The remedies that may be for a time 
employed at properly regulated intervals are : castor oil, 
olive oil, rhubarb, magnesia, sulphate of soda, Seidlitz 
powders or citratized magnesia. It will, however, be 
better if the patient can be induced to rely upon and use 
injections of soapsuds or of castor oil, molasses and 
water. These are invaluable in removing the hardened, 
faecal matter that almost always collects in the lower 
bowels. In the course of twelve or fifteen days you must 
try to do away with the use of either aperients or injec- 
tions and depend upon a well regulated diet, regular 
habits — going at a certain hour each day and making an 
honest effort at stool — and the use of tonics. For this 
purpose quinine may be used in one or two-grain doses 
every day, tincture of Peruvian bark in one or two tea- 
spoonful doses, or tincture of the bark and tincture of 
Colombo, equal parts, in doses of two teaspoonsful two 
or three times a day. I have known obstinate cases of 
costiveness to be cured by the use of an egg beat up raw, 
sweetened and a little water or milk added to it and 
drank once, twice or three times a day, an hour before 
meal time. This acts as a mild aperient, while it has a 
tendency to build up the general system. After the 



AND ttUIDE TO HEALTH. 555 

stools become regular the use of it cau be gradually dis- 
pensed with. The diet and proper exercise in constipa- 
tion of the bowels are of much importance and must not 
be neglected. Tea and coffee must be dispensed with 
altogether; in fact but little "slops" must be taken. 
The patient must use solid animal and vegetable diet, 
using such articles as agree best with his stomach, not 
eating oftener than every six hours and taking plenty of 
time to chew the food well. If these important things 
are not attended to it will be next to impossible to cure 
the disease. The skin also must be attended to and kept 
clean and healthy by freqent baths and friction. 

When costiveness is an attendant on pregnancy but 
little more can be done than use the mild aperients or 
injections and give proper attention to the diet and exer- 
cise. Dr. Tanner says : " Daily exercise in the open air, 
either on foot or on horseback, stands foremost among 
the remedies for constipation. General indolence, with 
too much sleep, must be avoided. There are very few 
cases of costiveness with dyspepsia arising from seden- 
tary pursuits that may not be cured by the sufferer 
drinking a tumbler full of spring water, retiring to bed 
at eleven o'clock and rising at seven o'clock and taking a 
bottle of soda water, then walking for three-quarters of 
an hour and afterward breakfasting upon weak tea with 
plenty of milk, meat, bread," &c. It is often the case 
that by gently kneading the bowels an action may be 
had daily, particularly in children and old persons. The 
bowels are generally much neglected, particularly by 
women; it is almost impossible to get them to attend 
properly to their bowels, and owing to this very neglect 
they often suffer severely. It should be the rule of every 
one's life to see that the bowels are regularly evacuated 
at least once daily, and for this purpose every one should 



5~>6 THE FAMILY PHYSICIAN 

have a certain hour to go to stool and make the effort. 
Habit has much to do with us in this as well as in almost 
every respect 



TABLE OF DOSES EOE CHILDREN. 



It must Tbe Tborne in mind that the amounts stated for 
a dose in this hook is intended for adults, unless it is 
otherwise stated at the time. As a general rule the dose 
for a child under one year old will "be from one-sixteenth 
to one-twelfth of that for an adult, at two years old one- 
eighth, at three years old one- sixth, at four years one- 
fourth, at six or seven one-third, at twelve one-half, at 
sixteen two-thirds, at twenty-one years old a full dose. 
This rule must be varied according to circumstances, the 
strength of the child, &c. 

Children can not take opium and its preparations in 
doses as large in proportion, but must have more calomel 
than the proportion as above. Mild purgatives will be 
oftener indicated in the treatment of children than adults, 
and will almost always give relief. 



PURE DRUGS. 



It is always necessary to procure good, fresh drugs. 
If you fail to do this you will be doomed to disappoint- 
ment. I have long dealt at two drug stores in St. Louis, 
and take pleasure in recommending each of them to the 
public. One is on the corner of Fifth and Market streets 
— the firm of Jones and Sibley — the other on the corner 
of St. Charles and Sixth streets — the firm of T. &. E. 
Catlin. Both are entirely reliable. 



AND GUIDE TO HEALTH. 557 



DISEASES PECULIAR TO WOMEN. 

AILEXOBBHCEA— ABSENT MENSTBUATIOK 



Amenorrhcea is the name given to absent menstruation, 
either when it has never appeared, or been obstructed by 
some cause or other after its appearance. The name 
emansio mensium has been given to that form of amen- 
orrhcea in which the menses have never appeared, and 
sup2 )ressi '° mensium is the name given that form in which 
the menses have appeared and then been obstructed from 
some cause. A third class might be added, consisting of 
those cases in which menstruation is irregular as to time, 
quantity or quality, but without actual suppression. It 
will be necessary to notice each one separately. 

ABSENT MENSTRUATION. 

SYMPTOMS. 

Emansio mensium, that form called amenorr7icea, in 
which the menses have never appeared, is ushered in by 
shivering, pain in the back and loins, aching along the 
thighs, with a feeling &f weight in the lower parts of the 
body at the time when the menstrual effort comes on. 
There is also a general lassitude and uneasiness. 

A very great difference exists as to the period of the 
commencement of menstruation in different climates. In 
warm climates it appears at a much earlier age than in 
cold, while it may appear in the South at as early an age 



558 THE FAMILY PHYSICIAN 

as eleven years. It seldom appears in the New England 
States at an earlier age than fifteen ; in fact, fifteen may 
be set down as an average in the New England and the 
Western States. It varies, however, in the same conntry 
in different individnals, corresponding generally with the 
development of the body and genital organs. 

In addition to the symptoms above enumerated, severe 
headache, fullness and throbbing of the temples, intol- 
erance of light and sound, irregular action of the stomach 
and bowels, with general debility, hysteria, and some- 
times chlorosis, attend this form of absent menstruation. 
These attempts at menstruation may occur and pass off 
every month, causing the patient much pain and often 
permanently impairing her health. They should always 
be attended to just as soon as they make their appear- 
ance. The mother or guardian of any young lady who 
fails to acquaint her with the fact that at puberty she 
must expect the appearance of her menses, and all 
the facts in relation to them, fails to discharge her duty 
to that young lady, and such dereliction of duty is unpar- 
donable, as it may cost her much pain and suffering, and 
perhaps her constitution and life. 

TKEATMENT. 

It is sometimes the case, but very rarely indeed, that 
the ovaries or uterus are wanting. In such cases there 
can be no remedy. In other cases it may occur from 
an imperforate hymen — a thin membrane across the 
vagina — through which there is no opening and the 
menstrual secretion can not escape. This is not a serious 
obstruction, as this membrane is generally thin and ten- 
der and may almost always be ruptured with the finger 
with very little pain. If this can not be done a surgeon 
must be called in, who can readily make an incision with 



AND GUIDE TO HEALTH. 559 

a knife. The operation is very simple. If there are other 
malformations, which do sometimes exist, such as no 
canal in the uterus or extensive obliteration of the vagina, 
the case must he placed in the hands of a skillful surgeon. 
Such cases as these, however, very rarely exist. If none 
of them exist and there is absence of chlorosis, the case 
is one of simple amenorrhea and must be treated as such. 
The treatment will vary according to the condition of the 
patient ; if she is of full habit, seems robust and healthy, 
with the exception of these menstrual efforts, she must 
use some mild laxative medicine, such as citratized mag- 
nesia, just enough to keep the bowels in a soluble con- 
dition, using also at least once a week a cathartic — the 
compound cathartic pill of the U. S. Dispensatory (a 
formula of which may be found in this work) is perhaps 
the best. 

The whole surface of the body should be washed as 
often as three times a week with tepid water, to which 
enough soda has been added to make it feel sleek. After 
the washing considerable friction should be used. This 
course must be persevered in until the menstrual eflort 
commences again, at which time she should drink freely 
of warm pennyroyal or tansy tea, taking a hip or vapor 
bath each night during the period. During the intervals 
between these efforts the patient must take plenty of ex- 
ercise in the open air. This in no wise must be neglected. 
If the patient is weak and nervous she should keep her 
bowels in a soluble condition or open, as above described, 
omitting the use of cathartics. During the interval be- 
tween her menstrual efforts she should use the syrup of 
iodide of iron in doses of from twelve to twenty drops, 
three times a day, adding two or three teaspoonfuls of 
water to it just before taking. The diet should be 
composed of good, nourishing and easily digested food, 



560 THE FAMILY PHYSICIAN 

such as soft-boiled eggs, potatoes, carrots and other good 
vegetables, and beefsteak or mntton. These should be 
cooked in a manner not to have too much oil about them. 
A common mode of cooking beefsteak, in the country 
particularly, is to place the beef in a vessel containing 
enough " hog's grease " to cover it, and allow it to soak 
there for an indefinite time, and when it comes to the 
table it is no more fit to be eaten than the fat portions of 
the filthy animal (the hog) itself. This is often done 
without the grease even being hot, which is much worse 
than if it were, for then the heat would close the pores 
a little by crisping them, and the oil would not find its 
way into the meat so freely. A piece of beef that will 
not furnish juice enough to cook itself is not fit to be 
eaten. An excellent mode is to take the steak, beat it 
a little and then place it, after it has been properly salted, 
in an ordinary skillet, cover it up and place it on a 
pretty hot fire. When one side is brown turn it over, 
and when done put on it about half an ounce of fresh 
butter, and pour on it three or four tablespoonfuls of 
good, strong coffee, then take it up and it is ready for 
use, with a rich and excellent flavor, palatable to any 
person of correct taste, and forming an excellent article 
of generous diet. Mutton or venison may be prepared in 
the same manner. If, in addition to this diet, the patient 
finds it palatable to her taste and convenient, she can 
use good ale (not lager beer). Young's pale is the best ; 
or good porter can be used with very great benefit. 

She must take exercise — not active enough to fatigue 
her, but enough in the open air to increase the circula- 
tion of her blood ; her body must be rubbed daily with 
a moderately coarse towel and sponged lightly twice a 
week with tepid alkaline water. She must, in her diet, 
avoid all acids and fat, particularly that of the hog. If 



AND GUIDE TO HEALTH. 561 

she eats hog meat at all let it be the lean portion of the 
ham, "broiled or boiled. 

If there is severe pain dnring those menstrual efforts 
she may take Dover's powder in five-grain doses every 
four hours until she experiences relief, which will be 
given by the time she has taken two or three doses. If, 
instead of the regular catamenia or menses appearing, 
only a white discharge appears at the regular time, it 
only proves that the uterus is working, but that there is 
a deficiency in the blood, which you are to supply by a 
continuance of the means recommended, with the excep- 
tion of the syrup of iodide of iron, for which you will 
substitute the carbonate of iron in two-grain doses three 
times a day. The patient will be benefited by the society 
oi lively, cheerful companions, a change of scenery, 
air, &c, &c. 

SUPPRESSED MENSTRUATION, 

Suppressio Mensium, is that form of amenorrhea in 
which the menstrual flow has appeared and been from 
some cause stopped ; it may occur at any time from the 
commencement of the courses, or puberty, to the "change 
of life." "When it occurs suddenly, it is called acute, 
and when gradually, chronic amenorrhea. 

SYMPTOMS. 

Acute amenorrhea is characterized by fever, headache, 
thirst and' quick pulse. The brain, lungs, womb or 
bowels may be attacked by inflammation. The symp- 
toms, however, will be found to vary much in their 
severity. 

In acute amenorrhea the patient will be subject to 

fainting, hysteria, loss of voice and skin disease ; even 
36 



562 THE FAMILY PHYSICIAN 

apoplexy has followed a sudden suppression of the 
menses. 

Neuralgic pains often attack the womb ; paralysis will 
sometimes occur. This is decidedly the most serious 
form of amenorrhea. 

The menstrual now is sometimes suppressed without 
producing any very marked effect or serious disturbance 
just at the time, consequently all the symptoms above 
enumerated are not always present. But the very 
earliest possible attention should be given to the patient 
or serious consequences may follow. 

TKEATMENT. 

The first object when the flow is suppressed is, to recall 
it as soon as possible. This may be done by the use of 
the warm hip bath, and the free use of tansy or penny- 
royal tea. If the pain is severe in the womb, a full dose 
(ten grains) of Dover's powder should be given. If the 
bowels are costive, give a full dose of senna and salts, 
or three of the compound cathartic pills, U. S. Dispensa- 
tory. If the discharge is restored, great care should be 
taken to observe that it appears at the next menstrual 
period. During the interval the patient must use some 
good tonic — a tincture of cynchonia or some of the prepa- 
rations of iron. If it is not properly restored it may 
terminate in chronic amenorrhea. 



AND GUIDE TO HEALTH- 563 



CHRONIC AMENORRHEA. 



This disease may be the result of an acute attack, or 
it may be caused by other circumstances, as disease of 
the womb, ovaries or other organs, or from a gradual- 
loss of health. 

SYMPTOMS. 

" Chronic amenorrhea, when not the result of an acute 1 
attack, may come on gradually, the discharge being 
uncertain and irregular in its appearance, but slowly 
diminishing until it ceases entirely ; or there may be a 
white fluid alternating with the red. There will usually 
be pains in the head, back and side, irregular and defi- 
cient appetite, a gradual failure of the vital powers,, 
ending in a confirmed deterioration of health, most 
favorable to an attack of some of the fatal organic 
diseases peculiar to the climate in which the patient 
resides." 

TEEATMENT. 

" We must be careful to ascertain that the case is one 
of chronic amenorrhea, and not of pregnancy, before 
attempting treatment. And again, should the suppres- 
sion occur at that period when the ' turn of life ' is 
expected, great care should be taken not to use too 
active medication, but only to palliate severe symptoms,, 
else much mischief might be done. 

""Whenever we can ascertain the cause of chronic sup- 



564 THE FAMILY PHYSICIAN 

pression of the menses, as, for instance, the disease pre- 
sent which occasions it, we nrnst pursue measures calcu- 
lated to overcome this, whatever it may he, and it will 
generally be found that on the patient's recovery the 
menses will return. Under other circumstances, the 
"better course will be a tonic and alterative treatment." 
Give a solution of iodide of potassium, two drachms 
to four ounces of water, one teaspoonful, three times a 
day, in two tablespoonfuls of sweetened water; and a 
powder of quinine, twenty grains, and carbonate of iron, 
forty grains, made into twenty powders, one to be taken 
night and morning. This medicine should be continued, 
as well as the iodide of potassium, during the whole 
interval between the menstrual periods. 

The bowels should be regular, the surface of the body 
bathed every day or two with a weak alkaline solution, 
rendered slightly stimulating by the addition of a little 
alcohol (or whisky). Exercise in the open air, propor- 
tioned to the strength of the patient, is a very important 
measure, and must by no means be neglected ; indeed, 
females, as a general rule, do not take sufficient exercise 
in the open air, and a great part of their difficulties will 
be found owing to those sedentary and unnatural cus- 
toms which society unjustly imposes upon them. If wo- 
men would go more among their friends or acquaintances 
and circulate more freely in the open air, either on foot 
or on horseback, allowing the •" gentle zephyrs to fan their 
fair cheeks," instead of remaining so much at home and 
in doors, in place of the pale, sickly hue that many of 
them continually wear their cheeks would bloom with 
the rose tint of health and their spirits, instead of remain- 
ing forever gloomy and sad, would be exuberant and joy- 
ous. Woman's sphere has been narrowed down to too 
narrow a channel. No wonder the cry is raised by a few 



AND GUIDE TO HEALTH. 565 

noble spirits for more freedom and for more liberties for 
women. It will be caught up by others who have no- 
bility of soul enough to take that broad and extended 
view of the matter that justice and humanity demands, 
and heralded over this broad, free country of ours in 
tones of thunder so loud that the deaf, narrow-minded 
old fogies who are now so firmly opposing it will hear 
and tremble and step to one side while the ever-rolling 
stream of progress sweeps proudly and defiantly by them. 
In addition to a general course of exercise in the open air 
a nutritious and generous diet must be allowed ; coffee and 
tea must be used very sparingly. Almost every person 
has fallen into the pernicious habit of drinking something 
or other continually while taking a meal. This is to be 
seriously regretted ; the meal should be taken without 
slops, and if you must drink, do so at the close of the 
meal. Masticate your food well and you will have no 
occasion for any fluid to " wash it down," the salivary 
glands will supply an abundance for that purpose. The 
great object in the treatment of this disease, and in fact 
most of the diseases peculiar to women, is to try to bring 
the system to a general healthy standard and then the 
local difficulties will disappear. This can not be done 
by medicine alone, nor can it be done by diet and exer- 
cise alone ; but all judiciously attended to, if there be no 
organic disease, must succeed. 

DYSMENOERHCEA. 

Painful or difficult menstruation is the term applied 
to menstruation which is attended with more or less pain. 
It may be moderate or it may be very violent, rendering 
the patient a permanent invalid from its repeated shocks 
to the constitution. It may appear before or after the 



566 THE FAMILY PHYSICIAN 

menstrual discharge. From the variation of its symp- 
toms it has been divided into three forms, the neuralgic, 
the inflammatory and the mechanical. This division is 
only necessary in order to give the symptoms, for the 
treatment is the same. 

SYMPTOMS. 

The neuralgic variety of dysmenorrhea is generally 
met with among delicate or nervous females. The men- 
strual flow is either preceded or succeeded by a headache, 
which sometimes alternates with pain low down in the 
back and extending to the lower part of the abdomen 
and down the thighs. The pain may be constant or may 
occur in paroxysms, with intervals of ease, and it is fre- 
quently so violent as to be almost insupportable. It 
usually lasts from six to twelve hours, when the appear- 
ance of the flow relieves it in a great measure. The dis- 
charge may be diminished, paler than usual and mixed 
with clots, and sometimes there is a membrane passed 
looking somewhat like the thin skin situated between the 
white and shell of an egg. Ordinarily the general health 
suffers but little, though sometimes it becomes perma- 
nently impaired. 

In the inflammatory variety there is a severe pain 
across the back, aching of the limbs, weariness, intoler- 
ance of light and sound, flushed face, hot skin, and a 
full, bounding and quick pulse, often over one hundred 
beats in a minute. The fever may run so high that tem- 
porary delirium will supervene. There will also be con- 
siderable swelling and congestion of the cervix and great 
heat about the parts. The menstrual flow is usually 
more abundant than in the neuralgic variety, and when it 
occurs all the severe symptoms are relieved. The thin 
membrane found in the preceding variety may also be 



AND GUIDE TO HEALTH. 567 

met with in this. Inflammatory dysmenorrhcea may be 
accompanied with falling of the womb, uterine leucorrhea, 
or ulceration of the neck of the womb, the last of which 
can only be detected by the speculum, and each of which 
must be removed by appropriate treatment before a per- 
manent cure can be made. During the intervals between 
menstruation the patient's general health is seldom 
affected. 

The symptoms of mechanical dysmenorrhea are some- 
what similar to the preceding, varying according to the 
causes occasioning it and the attending circumstances. 
In all the varieties of dysmenorrhcea sterility is the gen- 
eral rule, pregnancy the exception. 

CAUSES. 

Neuralgic dysmenorrhcea may be caused by cold taken 
during menstruation, or subsequent to a miscarriage or 
delivery, or it may follow some sudden or severe shock 
or mental emotion occurring at the menstral term. It 
may be mistaken for mi abortion, but may be distin- 
guished from it by & knowledge of its previous monthly 
character and by the quantity of blood being less than 
in abortion. Inflammatory dysmenorrhcea is more com- 
mon to plethoric females and those of sanguine temper- 
ament, and may be caused by some circumstances which 
will give rise to the preceding form. Mechanical dys- 
menorrhcea is owing to a narrowing or constriction of the 
canal or neck of the womb, which may be the result of 
inflammation or a long continued falling of the womb 
and bending ^of the uterine neck. 

TREATMENT. 

The bowels should first be acted upon by purgative 
Seltzer water, or solution of citrate of magnesia or Seidletz 
powders. Then the compound powder of ipecac and 



568 THE FAMILY PHYSICIAN 

opium (Dover's powders) in doses of five grains every 
.three hours until the patient experiences relief. A 
fomentation of hops or tansy in the meantime may be 
applied to the lower part of the bowels, or the spirit vapor 
bath may be given, which generally gives immediate 
relief. The above course will relieve the immediate and 
painful symptoms. The next care will be to use means 
to prevent the return of the disease. 

Dr. John King, Professor of Obstetrics and diseases of 
women and children in the Eclectic College of Cincinnati, 
whose interesting lectures I had the pleasure to listen to 
during the winter of 1855-56, recommends very highly 
the following pill : Camphor, pulverized, one scruple and 
a half, sulphate of quinine two scruples, extract of stra- 
monium one scruple, aletridin sufficient quantity to form 
the whole into a pill mass ; mix and divide into eighty 
pills, of which one may be given every four or five hours. 

In this, as in the other forms of derangement of the 
menstrual discharges, great care should be taken to use 
a proper, nutritious and easily digested diet, with plenty 
of healthful exercise in the open air. If the above pill 
should fail, reliance may be had on the preparations of 
iron — the tincture, if it agrees with the stomach, stand- 
ing at the head of the list. If ulceration of the womb be 
present it must be treated as recommended under that 
head, or if falling of the womb is present it must be re- 
placed and treated as directed under that head, 

" The mechanical form of dysmenorrhea can only be 
remedied by the delicate and cautious employment of 
bougies, commencing with one of small size and gradu- 
ally increasing it until the canal is sufficiently dilated. 
These must be allowed to remain in only a few minutes 
at a time and should be reapplied in two or three days, 
according to the irritability of the patient and the symp- 



AND GUIDE TO HEALTH. 569 

toms produced. Any inflammatory symptoms of the 
part caused by their employment will give way to rest 
and quiet, keeping the bowels regular and an injection 
of warm water into the vagina two or three times a day." 

MENOERHAGIA. 

Immoderate flow of tlie menses is the term applied to 
all large or immoderate discharges or flows of blood that 
take place from the womb at other times than during 
pregnancy or labor. Uterine hemorrhage or flooding is 
the term applied to all discharges occurring during gesta- 
tion or parturition (labor), or which are owing to polypi, 
ulcers or wounds of the womb. 

Menorrhagia may exist in two ways : the menstrual 
flow may appear every two or three weeks instead of 
every four, or it may occur at the regular time, but in 
profuse quantity, or it may occur at unexpected and un- 
common seasons, as during pregnancy or in the early 
months of suckling. It is divided into two forms — the 
active and passive. 

SYMPTOMS. 

In active menorrJiagia the prominent symptom is a 
profuse discharge. This alone is enough to make a cor- 
rect diagnosis from. There will be, however, several 
other symptoms present, as sudden flushings, alternating 
with chilliness ; a sense of heat and fullness, frequent 
throbbing pulse, pains in the back and loins, which are 
frequently relieved upon the escape of blood. The blood 
is of a florid, red color. The discharge sometimes con- 
tinues for a month or more, but most frequently ends in 
eight or ten days, reappearing at the next menstrual 
period. 



570 THE FAMILY PHYSICIAN 

CAUSES. 

Active menorrhagia may be occasioned "by lifting 
heavy weights, tight lacing, excessive use of strong tea 
and coffee, cold, strong passions, abuse of stimulants, 
excessive venery, and whatever will occasion debility of 
the womb. Its periodical character will serve to distin- 
guish it, though it may exist in connection with a uterine 
polypus. 

Passive menorrliagia may be the result of the active 
form, or it may have been passive from its commence- 
ment, as is apt to be the case among females of weakly, 
irritable and delicate habits. It is a more serious form 
of hemorrhage than active, and if not speedily arrested 
may assume a formidable character. 

SYMPTOMS. 

In the passive form of menorrhagia the blood dis- 
charged is dark-colored, resembling venous blood. The 
strength of the patient becomes rapidly reduced, the 
countenance pale, pulse quick and feeble, the extremities 
cold, and sometimes the whole surface of the body ; a 
distressing sensation of faintness is generally experi- 
enced, giddiness and occasional nausea and vomiting, 
and a very common symptom is a sense of weight and 
pain in the head, especially over the eyebrows and fore- 
head. In the more severe and dangerous forms difficult 
and laborious breathing will be present. But the dark 
discharge of blood from the vagina, continuing for a few 
days, is the prominent symptom, and enough to make a 
correct diagnosis from. 

TKEATMENT. 

In the active form, if the patient be of full habit, but 
little treatment will be necessary, unless the flow is very 



AND GUIDE TO HEALTH. 571 

great or the constitution seems to suffer from it. Some- 
times it may remain for years and only subject the 
patient to some inconvenience — not seeming to affect the 
general health but very little, if any. This is not always 
the case, however, for sometimes its effects are plain to 
be seen in a short time, and, if it is allowed to proceed, 
the consequence is very serious. The principal means 
to check it are, to keep the patient in a quiet, horizontal 
position ; keeping the bowels regular by such mild laxa- 
tives as citratized magnesia ; bathing the external parts 
with vinegar and water, by means of a wet cloth ; and 
giving astringents internally, such as tannin one grain, 
alum two grains and gum kino two grains, repeating it 
five or six times a day. Give also six to ten grains of 
Dover's powders twice a day. The patient's feet must 
be bathed in water as warm as she can bear, two or three 
times a day ; it is well to add salt to the water. During 
the exhibition of these remedies she may drink freely of 
a decoction, or tea made of beth root, blackberry root, 
geranium, and the inner bark of white oak, or, if these 
articles can not all be procured, any one or two of them. 
During the intervals between the flow measures must 
be taken to prevent its return: the patient should be 
kept quiet ; the diet should be spare, but nutritious ; 
the bowels must be kept regular by very mild aperients, 
such as citratized magnesia. The skin must be carefully 
attended to by a sponging, two or three times a week, in 
tepid, alkaline bath. The above tea and powder of 
tannin, alum and kino may be continued occasionally 
through the interval, but they need not be given oftener 
than once or twice a day. A pill— of quinine thirty grains, 
carbonate of iron one drachm, and opium twenty grains ; 
mix and divide into forty pills, and take one night and 
morning. Tea nor coffee must not be allowed her ; nor 



572 THE FAMILY PHYSICIAN 

can she be allowed any active exercise, nor in fact, any 
at all if the case is a very bad one ; but if a mild one, 
she can take a little exercise with advantage, provided, 
great care is taken not to exert herself any. 

TKEATMENT. 

Of the passim form of menorrhagia, in very mild cases, 
the tincture of cinnamon given in teaspoonful doses 
every hour, in a wineglassful of sweetened water, will 
often give relief. Or the powder, tannin one or two 
grains, alum two grains, and gum kino two grains, may 
be given ; also, the decoction or tea of the astringent 
articles mentioned in the treatment of the active form. 
If the patient seems much depressed, warmth must be 
applied to the feet, knees and arms, by means of bottles 
of warm water, hot bricks or irons. If the discharge is 
very great and seems to be depressing the patient, resort 
must be had to the tampon. This may be done by taking 
several pieces of soft linen, muslin or silk, or a piece of 
sponge moistened with some astringent fluid, and passing 
it into the vagina so as to plug it up. This will, by 
causing a clot to form around the openings of the bleeding 
vessels, prevent, at least for some time, any further 
effusion. But the plug thus made must not be removed 
too soon, or the hemorrhage will recur — it should remain 
for three or four days. If it causes bearing-down pains, 
a desire to stool or to urinate, it must be removed. 

The bowels must be kept regular during the interval ; 
and nutritious diet allowed, with ale or porter, &c. The 
quinine and iron pill must be used as in the active form ; 
and astringents once or twice a day. Alum water must 
also be injected well up into the vagina three or four 
times a day. Attention must be given to the skin, as in 
the preceding form, adding a little spirits to the bath to 
stimulate the skin. 



AND GUIDE TO HEALTH. 573 



CESSATION OF MENSTRUATION. 



" Cessation of menstruation generally occurs after the 
menstrual function lias been performed for thirty or 
thirty-five years, or about the forty fifth or fiftieth year 
of life, and is always looked upon by females with some 
degree of anxiety. In consequence of the difficulties 
which occasionally develop themselves at this time, it 
has been variously called the ' critical age,' c turn of 
life,' ' change of life,' &c." 

SYMPTOMS. 

Among healthy females it is not common for them to 
suffer much ; they generally become stouter and the 
abdomen and breasts frequently enlarge to such an extent 
as to lead them to think they are pregnant. The dis- 
charge usually diminishes, gradually assumes a paler 
color and eventually ceases permanently ; or it may occur 
at uncertain or distant periods, or alternate with a white 
discharge. Sometimes there will be a profuse, bloody 
discharge, and the function become suspended for the 
remainder of life. 

Among delicate females and those who have suffered 
from previous diseases of menstruation, it is not uncom- 
mon to meet with excessive menorrhagia or severe re- 
peated attacks of uterine hemorrhage, jeopardizing life. 
The same may be said of those who have been intem- 
perate in their passions and pleasures. The symptoms 



574 THE FAMILY PHYSICIAN 

attacking these vary considerably : much pelvic irrita- 
tion, with a bearing down sensation, a desire to stool 
or forcing backward, frequent inclination to urinate, 
heat and smarting of the parts and tenderness of the 
vagina, are very apt to be present. A troublesome itch- 
ing of the parts of generation is a common accompani- 
ment. The person becomes irritable, uneasy, restless, 
with more or less changes of the moral and mental dis- 
position. With some the skin loses its color and supple- 
ness and becomes sallow and wrinkled, the hair falls off 
or turns gray, the breasts, at first flaccid and pendulous, 
finally disappear and: the voice becomes masculine.. At 
this time various diseases are apt to become manifest, 
some of which may probably have existed for some time in 
a latent state, as vertigo, hysterics, colic, piles, cutaneous 
eruptions, ulcers of the legs, hemorrhages from various 
parts, inflammation of various organs, dyspepsia, palsy, 
apoplexy, insanity, cancer of the womb, profuse sweats. 

TKEATMENT. 

Generally there is little else required than to keep the 
bowels regular. This may be done by the use of the 
citrate of magnesia or Seidlitz powder.. Attention must 
be given the skin, as in the preceding forms of menstrual 
derangement. The diet must be of a good, nutritious and 
wholesome character. If hemorrhage should be too free, 
treat it as recommended in menorrhagia. The patient 
must be very careful about this time to avoid any ex- 
posure to cold or any thing that would be likely to cause 
local disease. When the discharge ceases suddenly, or 
when there is giddiness or occasional pains in the head, 
a mild purgative may be taken, as the compound pow- 
der of leptandrin, and this should be repeated whenever 
the symptoms may require. 



AND GUIDE TO HEALTH. 575 

If secondary disease should arise it must be treated as 
a primary attack. In most cases when there is a tendency 
to secondary diseases, alteratives will be required, and 
none excel the compound syrup of stillingia, with iodide 
of potassium. Syrup of stillingia compound eight ounces, 
iodide of potassium two drachms ; take one teaspoonful 
three times a day. When the compound syrup of stil- 
lingia can not be procured, iodide of potassium may be 
taken alone — two drachms in four ounces of rain water — 
dose, one teaspoonful three times a day; or syrup of 
iodide of iron twenty drops three times a day. Any 
nervous derangement must be treated as recommended 
under the head of hysteria. 



LEUCORRHEA. 

WHITES— FLUOR ALBUS. 



By this is meant a discharge from the vagina (or the 
female organ of generation), either of a white, brown or 
greenish color, sometimes very acid, and excoriating the 
parts so much that they smart and are very painful. It 
is a disease that very few women indeed, escape through 
life, and as the demands of society still continue to 
diminish the general health of women the disease in- 
creases. It is a sad spectacle, indeed,, for the man of 
sense to view the wasp-like shaped waists of many of 
the women we see on the streets. Their chests are com- 
pressed in such a manner that the organs are displaced ; 
the stomach is forced down into the abdomen, presenting 



576 THE FAMILY PHYSICIAN 

an unsightly appearance from its increased size; the 
intestines, from having to make room for the stomach in 
the space allowed them, displace the womb and press it 
into the vagina or even ont to the external surface. If 
this organ is at all displaced there is an irritation set np 
both in it and the vagina which is termed leucorrhea. 
Besides this, the stomach and bowels are so cramped for 
the want of room that digestion is but poorly performed, 
the peristaltic motion of the bowels is interfered with, 
and costiveness is the inevitable consequence. Nutrition 
then, of course, is interfered with or imperfect and insuffi- 
cient, and the general health is impaired, so that the age 
of thirty — the age that ought to find women in the prime 
of health, beauty and vigor — finds many of them miser- 
able wrecks, laboring under leucorrhea, falling of the 
womb, hysterics, etc., etc. 

SYMPTOMS. 

The discharge from the vagina may be scant or profuse, 
of a whitish brown or green color, according to the severity 
of the attack. If scanty and white the attack is mild, 
if brown or green and more profuse it may be considered 
more severe and more obstinate, and will be found to 
weaken and debilitate the patient very fast, causing a 
disagreeable sense of pain and weight in the back and 
loins, sour stomach, pale countenance, depraved appetite, 
colic, palpitation of the heart, and great nervous derange- 
ment, with mental depression, small and frequent pulse, 
her flesh is soft and loose, her breasts soft, the breath 
fetid, the feet and ankles swollen, and hysterics, with 
dropsical swellings of the whole body. 

"When the mucous discharge is of a whitish color, 
about the consistence of cream, it comes from the vagina, 
and is not so difficult or so injurious to the patient ; but 



AND GUIDE TO HEALTH. 577 

if neglected, as is too often the case, it will destroy the 
constitution and make life a burden. Each individual 
ought to inform herself and be able to detect disease in 
its very commencement, and then cut it short and save 
the constitution. When the discharge is from the vagina, 
as above, it communicates a stiffness to linen upon which 
it has dried, leaving a grayish spot, deeper at the edges. 
This form is accompanied often with a troublesome itch- 
ing and relaxation of the walls of the vagina. 

When the discharge is transparent, about the consis- 
tence of the white of an egg, communicates no stains, 
but only a starchy appearance or hardness of the linen 
upon which it has been allowed to dry, and has a ropy, 
slimy, tenacious consistence, it comes from the neck of 
the womb or its canal, and is a most obstinate form of 
leucorrhea, and one very commonly met with. 

There are two varieties of this disease, one termed 
mucous and the other purulent. The latter is character- 
ized by a discharge from either the womb or vagina of a 
purulent matter; sometimes greenish, or of any shade 
from a very light yellow to a dark brown, staining linen 
very deeply, and is only removed with difficulty by hard 
washing. 

This discharge almost always issues from an ulcer or 
excoriation on the neck of the womb, but sometimes 
from some place in the vagina. This can always be 
determined by using the litmus paper, as the discharge 
from the vagina is always acid, while that from the womb 
is always alkaline. 

This purulent form of leucorrhea often becomes of such 

an acrid and irritating character as to communicate a 

disease resembling gonorrhea — almost precisely — and 

one that, without the use of the microscope, it is almost 

impossible to distinguish from that disease. 
37 



578 THE FAMILY PHYSICIAN 

In gonorrheal matter the microscope reveals animal- 
cules at a power of about three hundred, while in that 
of leucorrhea there are none. 

It is very important sometimes to be able to make this 
diagnosis properly ; the happiness of a family may 
depend upon it. 

CAUSES. 

The causes are very numerous ; too much so to attempt 
to mention them. In fact, any thing that is calculated to 
debilitate the system may be named among the causes. 
The exciting causes may be, excessive coition, child 
bearing in very rapid succession, or very difficult deliv- 
eries, cold, dampness, masturbation, purgatives, too long 
suckling, irritation of the rectum caused by worms or 
piles, a sedentary life, sudden mental or physical shock, 
excessive menstruation, &c. ; in short, any thing that is 
calculated to unduly excite the parts or debilitate them. 

Frequent attacks of leucorrhea at the present time 
seem to be almost the common lot of women from the 
age of puberty to the grave, particularly that class who 
are rocked in the cradle of ease and luxury. The reasons 
are very apparent to the thinking man : the sedentary 
life, high living, uncomfortable fashionable dressing, 
and want of out door exercise, &c. The country woman 
who attends to her domestic duties, tends her cow and 
feeds her chickens, and takes an occasional lesson in her 
garden, unless she is very imprudent in some other 
things, will not likely have leucorrhea. 

TBEATMENT. 

The first care of the practitioner must be directed to 
the general health of the patient. The bowels must be 
regulated, which can best be done by diet, and the use of 
an injection into them of castor oil, molasses and warm 



AND GUIDE TO HEALTH. 579 

water if they are very costive. Reference is given to the 
article on that subject in another part of this "book. 
The skin mnst be daily sponged with tepid, alkaline 
water. Proper exercise in the open air mnst be taken. 
The cause that produced the disease mnst be removed or 
avoided. The diet must be good, easy of digestion and 
nutritions. The patient may take, three times daily, 
from ten to twenty drops of tincture of iron, in half 
a tumbler of water. If her courses are irregular, they 
must be attended to ; if too profuse, as is often the case,, 
they must be checked. If the womb is displaced, it 
must be treated as directed under that head. If there is- 
pain or scalding of the urine in voiding it, copaiba cap- 
sules may be taken, from six to nine of them daily. If 
the parts seem excoriated by the discharge, a wash of a 
weak solution of soda may be used, three or four times 
a day. 

In connection with this, in the purulent form particu- 
larly, and in forms in which there are ulcerations or 
excoriations of the neck of the womb, iodide of potas- 
sium, in from three to five grain doses, three times a 
day, must be given. 

If the patient is of a scrofulous habit or diathesis, 
pills or syrup of iodide of iron should be used. 

The means used in this complaint must be persevered 
in for a considerable length of time. 

Local applications are of much service in this com- 
plaint. A solution of tanic acid — grains ten; water four 
ounces — may be injected into the vagina, one ounce three 
or four times a day. A weak solution of sulphate of zinc r 
say four grains to the ounce of water, may be. thrown 
into the vagina three or four times a day. Injections 
will be found most agreeable if introduced warm. They 
must always be- retained for ten or fifteen minutes at 



580 THE FAMILY PHYSICIAN 

least, which, may be done by the patient lying on her 
back with her hips sufficiently elevated. The sugar of 
lead will sometimes give very prompt relief injected into 
the vagina in a solution of five grains to the ounce of 
water ; but it is not always desirable to use it for any 
length of time, as it is apt to collect and form a cake 
when there is any abrasion. But perhaps the best and 
most reliable application is a solution of nitrate of silver, 
from three to six grains to the ounce of rain water, injected 
thoroughly into the vagina two or three times a day. 
This is particularly serviceable when there is any ulcer- 
ation of the neck of the womb. If it become necessary 
to keep the walls of the vagina from coming in contact 
with each other, lint may be introduced, moistened with 
a solution of tannin and alum, or any of the local appli- 
cations above recommended. This must be removed and 
replaced by fresh lint two or three times a day. If the 
neck of the womb is ulcerated, it may become necessary 
to introduce a speculum and apply tincture of iron to it 
by means of a camel's hair pencil, or a solution of nitrate 
of silver, as the case may require. But if the patient 
faithfully attends to her general health and uses the 
means prescribed an improvement will soon reward her 
for her trouble. Obstinate cases will soon yield. Sexual 
intercourse, coffee, tea and late evening parties must be 
strictly forbidden. Good diet, with plenty of out-door 
exercise in the open air, must be enjoined. High sea- 
soned, stimulating food must be used sparingly. 



AND GUIDE TO HEALTH. 581 



FALLING OE THE WOIB 

(PROLAPSUS UTERI.) 



By falling of the womb is meant a displacement of that 
organ, in which it comes down much lower than it shonld 
"be, or than it is when in its natural position. It is owing 
to a want of tone, or to relaxation of the walls of the 
vagina and the ligaments that sustain the womb. 

SYMPTOMS. 

Falling of the womb may vary from a very slight 
descent below its natural situation to a projection through 
the external parts of the genital organs. A weight and 
bearing down in the parts is experienced, with a feeling 
of fullness in the pelvis, a sensation of dragging, which 
extends from the navel to the loins, with distress in 
standing or walking, constipation of the bowels, and 
difficulty in passing the urine, which is unusually hot, 
are the symptoms which accompany and characterize 
falling of the womb. Its effects are alteration in the rel- 
ative situations of neighboring organs, leucorrhea, pain- 
ful and excessive menstruation, derangement of the 
stomach and bowels, and depression of spirits. 

CAUSES. 

It may be brought on by coughing violently, vomiting, 
over- exertion, or lifting, or it may be the result of leucor- 
rhea, many child-bearings, repeated floodings, or any 



582 THE FAMILY PHYSICIAN 

other cause that debilitates the general system. It may 
happen during pregnancy or parturition. 

TKEATMENT. 

If nothing were done in the way of treatment for a 
patient laboring under this disease, she would become 
much distressed by all the symptoms which have been 
described. She might die from weakness induced by the 
large discharges and the disordered state of the stomach, 
or she might die from inflammation taking place in the 
parts contained in the inverted vagina, which are more 
liable to pressure than when in their usual place — the 
cavity of the pelvis and abdomen. Such fatal termina- 
tions are uncommon. It much more frequently happens 
that the patient drags on an uncomfortable life for a 
number of years, till she is destroyed by accident or by 
some other disease. In mild cases we can often succeed 
by acting medicinally upon the mucous membrane. In 
the severer ones we are obliged to have recourse to 
mechanical support. 

In recent cases of prolapsus, and where the womb is 
not protruded beyond the surface, the influence of proper 
agents, aided by rest in a recumbent posture, will gen- 
erally effect a cure, if properly persevered in. Cold 
water may be freely injected into the vagina, three or 
four times a day, and retained there for five or ten 
minutes. Also, an injection should be used of sulphate 
of zinc eight grains, and water one ounce, to be used at 
a single injection ; this should be repeated at least night 
and morning each day. If there be no abrasions, the 
sugar of lead may be substituted for the zinc with 
advantage, but when a surface is excoriated it is never 
good practice to use the lead; it is too likely to be 
deposited in such places and do much harm. 



AND GUIDE TO HEALTH. 583 

Tlie external parts of the genital organs, hips, loins, 
and the lower part of the abdomen mnst be frequently 
sponged with very cold water. The patient must remain 
as much as possible in bed or in a recumbent posture, 
using internally tincture of iron, begining with ten drops 
three times a day, in half a glass of water, and in- 
creasing one drop a day until the dose is fifteen drops. 
If there are no febrile symptoms, a good, nutritious diet 
should be used, avoiding as much as possible coffee 
and tea — using them, if at all, in very small quantities j 
in fact, it may be borne in mind that in all uterine dis- 
eases, with perhaps the exception of some conditions of 
amenorrhea, coffee and tea are positively injurious, 
and should be used, if at all, very sparingly. This will, 
doubtless, meet the condemnation of a large majority of 
my fair readers ; nevertheless it is true, and truth and 
correct principles must not, and shall not, be left unsaid 
in order to cater to popular taste. 

The clothing should be worn loose around the body, 
and stays and tight lacing must be dispensed with 
altogether ; in fact, tight stays have become a fruitful 
source of falling of the womb, crowding other organs 
down and displacing them, and they crowding down and 
displacing the womb. This course of treatment persevered 
in will seldom fail to give permanent relief, particularly 
in recent cases and where the displacement is not very 
great, and will sometimes relieve cases of long standing 
and complete prolapsus. In the commencement of the 
treatment of cases, however old or severe, it is always 
worth while to give this plan of treatment a fair and 
patient trial, first replacing the womb if the prolapsus is 
complete. Some of the very worst cases have yielded to 
it. If, however, it fails, mechanical means must be re- 
sorted to. If the patient is nervous and can not sleep at 



584 THE FAMILY PHYSICIAN 

night, she should take six or eight grains of Dover's 
powders. 

MECHANICAL TEEATMENT. 

When the descent of the womb is complete and pro- 
trudes through the external parts, it must be replaced ; 
this can be done easily by pressing it gently but firmly 
upward. When it is in the vagina one or two fingers 
should be introduced in' order to replace the womb as 
nearly as possible in its natural situation. This reduc- 
tion, however, must not be attempted if inflammation 
has at any time attacked the internal parts of the tumor, 
because if this should have happened and be connected 
with each other by coagulating lymph, the force neces- 
sary to accomplish the return of the tumor may separate 
the adhesion or tear the parts with which they are con- 
nected and the life of the patient be endangered. When, 
therefore, acute pain has occurred in the tumor, with 
marks of peritoneal inflammation, such as thirst, white 
tongue, small, quick pulse, tenderness of the abdomen,, 
no attempt should be made to replace it speedily. In. 
such cases it will be necessary to use means to subdue 
the inflammation. This may be done by the use of saline 
cathartics, the local application of cold water and the use 
of Dover's powders. The patient should take salts and 
senna every day until there is one or two free actions on 
the bowels each day. Apply cold water freely to the 
parts and at night take ten grains of Dover's powders. 
When the inflammation is subdued the parts may then 
be replaced and a pessary introduced into the vagina to 
hold the womb to its place. The patient is to continue 
in bed with the hips a little elevated for several hours. 

Pessaries are of various forms, and are made of sponge, 
wood, ivory, gum elastic, glass and silver, coated with 



AND GUIDE TO HEALTH. 585 

gold. The last mentioned is preferable, bnt too costly 
for common nse. Next to it, in my estimation, stands 
the gnm elastic, which is so constructed that it can be 
introduced and then inflated with air by the patient her- 
self. It must be frequently removed and cleansed. It 
will not be necessary, after a day or two, to wear the 
pessary at night while in bed, as the womb will stay 
in its proper place while in a recumbent posture without 
it. If pregnancy should happen there will be no occa- 
sion for the pessary after the third month, and by a 
careful and proper course of treatment after delivery a 
return of the prolapsus may be prevented. This will 
consist in a proper course of bandaging and keeping the 
patient a much longer time in a recumbent position in 
bed than is usual in ordinary confinement. After the 
pessary has been introduced, as above, the bowels should 
be kept open by gentle laxative medicine. If there is 
heat and any difficulty in urinating, balsam of copaiba 
capsules must be taken, which will soon relieve it. A 
tea made of watermelon seeds will sometimes answer the 
same purpose. The diet must be light and nutritious, 
the body sponged regularly with tepid water, to which a 
little soda has been added ; the tincture of iron must be 
taken for several weeks, and active exertion avoided. 



586 THE FAMILY PHYSICIAN 



REPRODUCTION. 

ITS IMPORTANCE AND NECESSITY. 



This subject is one that can not fail to interest every 
human being. It involves the important question — the 
origin and reproduction of our species. It is a topic at 
once full of interest, and not altogether free from mys- 
tery. I will only attempt to speak of generation so far 
as it relates to the production and development of the 
human foetus. 

" It may," says a writer, " however, be observed, that 
organized beings can be perpetuated only through repro- 
duction. Let the earth be covered, the waters filled, and 
the universal globe be crowded with living beings, and 
yet how soon would life become extinct and the world a 
blank were it not for the constant generation of new 
beings to take the place of those who have run their race 
and yielded to the inexorable demands of time. Look at 
the bills of mortality ; see what myriads of the human 
family are swept from the earth every year by disease 
and the natural decay of the system — and the same argu- 
ment applies to all animals — and then tell me whether 
this prodigious waste does not require a corresponding 
supply. It is with all living things as it is with the 
existence of governments and nations ; both are to be 
perpetuated through the laws of succession. Were it 
not for this great fact, how rapid and final would be the 
victory of death ! " 



AND GUIDE TO HEALTH. 587 

Beproduction, in its strict physiological meaning, im- 
plies the development of a being, so that it may be capa- 
ble of an external or independent existence ; hence it 
consists of a series of processes which, when completed, 
constitute the entire reproductive act. The first of these 
processes in the human species is the contact of the two 
sexes, known as copulation. The second process is fecun- 
dation, which consists in the exercise of a vitalizing influ- 
ence, through the male, on the germ furnished by the 
female. This act of vitalizing or imparting life gives 
rise to another process, conception. In strict physiolog- 
ical truth, it may be said the male fecundates and the 
female conceives. Then follows gestation, during which 
the embryo grows and becomes developed ; and when its 
development has become sufficiently accomplished labor 
occurs, the object of which is to expel it from the uterus. 
As soon as this is effected the entire relations of the new 
being are changed. It breathes, and therefore has a cir- 
culation of its own. It is no longer dependent upon its 
parent for the elaboration of its blood ; its lungs, which 
before birth were without function, commence at once 
their round of duty. The first gasp of the infant may 
be considered its declaration of independence. 

Its organic existence is now called into action ; it re- 
ceives food, which, through the operation of its digestion, 
is converted into chyle ; this latter passes through the 
thoracic duct into the venous system, whence, by the 
ascending and descending vense cavse, it is conveyed to the 
right cavities of the heart, and thence to the lungs, where, 
through the elaborate action of these organs, it becomes 
decarbonized, or, if you choose, arterialized ; it is then 
taken to the left cavities and distributed, through the 
ramifications of the aorta, to all portions of the system, 
imparting nutrition and development to every tissue. 



588 THE FAMILY PHYSICIAN 

It is a physiological truth, that reproduction is the joint 
act of the two sexes, and it now remains to be seen what 
science has disclosed as to the respective parts assumed 
in this wonderful scheme by the male and female. It 
would not be profitable to array before you the numerous 
and conflicting theories which have been maintained with 
more or less zeal on this subject ; I prefer rather to pre- 
sent to you what I believe, at the present day, to be the 
accepted and recognized facts touching this interesting 
topic. 

The germ cell. — The female in the act of reproduction 
furnishes the ovule or "germ cell," whdch is a product of 
the ovary. These organs — the ovaries — are the essential 
and only organs of generation, strictly so-called, in the 
female. At the time of menstruation, and just before 
each menstruation, on the surface of these organs (the 
ovaries) there is an ovule, contained in what is known as 
the graafian vesicle. At first the ovum is in the center 
of this vesicle, yet in proportion to the contents of the 
vesicle the tendency of the ovum is to move toward the 
circumference of the ovisac, so that just prior to its in- 
trusion it is quite near the surface of the ovary ; the ad- 
vance of the ovum toward the outer portion of the ovary 
is one of the ordinary processes preparatory to its fecunda- 
tion. This ovule has no inherent power of development 
beyond its mere growth as an ovule,, and after it has 
reached its maturity, if it be not vitalized by the male, 
it perishes and passes off with the menstrual blood. But 
if it should have life imparted to it by the seminal fluid 
of the male, it lives, becomes developed and constitutes 
the future being. Indeed, the ovule, at this special period 
of maturity, is not unlike the luscious peach, as it hangs 
in full ripeness and flavor from the parent tree ; if there 
be no hand to pluck it in its tempting richness, it falls to 



AND GUIDE TO HEALTH. 589 

the ground and decays. "Women, then, are most apt to 
become fecundated (or pregnant) at this particular time, 
just before menstruation, when the ovnle, in all its de- 
velopment, lies on the surface of the ovary ; therefore 
the theory that fecundation will not take place twelve 
days after the menstrual flow has ceased or during the 
last week before menstruation is an error ; and if the 
married woman who has never been blessed with off- 
spring, notwithstanding the years that she may have 
spent in unrequited effort and patient toil, will only have 
intercourse once a month with her husband, and that just 
before the menstrual period, she will not likely remain 
long barren. 

The sperm cell. — While it has been stated to be the 
office of the female to provide the ovule, it is the prov- 
ince of the male to impart to it life, so that it may attain, 
through successive development, its fetal maturity. But 
what is this vitalizing element ? The testes are to the 
male what the ovaries are to the female. They are 
glands which constitute the essential organs of genera- 
tion — they secrete, after the period of puberty, a seminal 
fluid. This fluid contains spermatozoa, which constitute 
the real fecundating element ; they are small filamentous 
bodies which enjoy the power of spontaneous motion ; 
they partake of the character of the reproductive por- 
tions of plants, which also possess a spontaneous move- 
ment as soon as they have been thrown from the parent 
mass ; and it is likewise conceded that the ciliated epi- 
thelia of mucous membrane will continue for some Lime 
in movement after their separation from the body. In 
man these are developed within the tubuli of the testicles 
in what are known as the spermatic cells, within each of 
which is a vesicle of evolution, as it has been termed, 
and in each vesicle there is a spermatozoon. The essen- 



590 THE FAMILY PHYSICIAN 

tial fact to be recollected is, that tlie spermatozoon repre- 
sents the trne fertilizing element and possesses the exclu- 
sive power of imparting life to the ovule of the female. 

The seat of contact between the germ and sperm cells 
is the ovary ; of this there can be but little doubt at the 
present day. 

The ovule finds admission into the fallopian tube by 
a combined contraction of the ovarian-tubal muscular 
fasciculi. It is a veritable spasmodic contraction of this 
muscular apparatus which consummates the contact. 

But the question arises as to the special influence 
which originates this muscular contraction, or, in other 
words, what is it that throws these fibres into action ? 
When the graafian vesicle has attained its development 
and is matured, the distention of the muscular fibres, 
proper to the stroma of the ovary, begets a reflex move- 
ment, which is immediately transmitted to the tubo- 
ovarian muscular system. This latter contracts, and this 
brings the extremity of the tube in close contact with 
the ovary. The ovule is detached, and then conveyed 
through the vermicular movement of the tube itself to 
the uterus, where it remains sufficiently developed to 
prepare it for an independent or external existence. 

I have given briefly what may be considered the 
accepted facts of science touching this interesting ques- 
tion of reproduction in the human species. 

PEEaNANCY. 

Pregnancy may be defined to be that condition of the 
female which exists from the moment of fecundation 
until the exit of. the child from the maternal organs. 
Much difference of opinion has existed as to the true 
nature of pregnancy, so far as the general laws of 
economy are concerned ; and conflicting views have been 



AND GUIDE TO HEALTH. 591 

advanced as to whether it is or is not a pathological or 
diseased condition. There can be no doubt that the 
general system, as the direct consequence of impreg- 
nation, undergoes numerous modifications; and it is 
entitled to consideration whether, as a general rule, 
these modifications should be regarded as evidences of 
morbid action, or whether, on the contrary, they should 
not be accepted as testimony that nature is engaged in 
the attainment of an object which she can not accom- 
plish except through the operation of certain changes, 
which, although not morbid, will necessarily encroach 
more or less on that integrity of functions or equili- 
brium of forces which, in the unimpregnated female, is 
looked upon as the standard of health. If the impor- 
tant and interesting period of gestation is indeed a 
period of diseased action, the destiny of woman would 
truly be one of bitter anguish, if, in addition to her 
other sorrows, it were decreed that, while engaged in the 
great act of reproduction of her species, she should 
necessarily be subject to the inconveniences and perils 
of disease. 

So far, then, from regarding gestation as a pathologi- 
cal or diseased state, I maintain that, as a general prin- 
ciple, it is entitled to be denominated a period of in- 
creased health. I am speaking now of the general rule, 
and not of the exceptions, to which I will hereafter 
direct your attention. It is a fact that the probability of 
prolonged life is increased as soon as pregnancy occurs. 
Let us now take the converse of this proposition, and 
you will see, in its results, an additional proof that ges- 
tation is not in truth a diseased condition. Look, for 
example, at those females who, either from choice or 
necessity, lead a life of celibacy, and see how much 
greater is the record of mortality. Marriage and preg- 



592 THE FAMILY PHYSICIAN 

nancy, therefore — however religion may fill the cloister 
Tby devoted and self sacrificing ladies — should be re- 
garded as among the covenants of nature; and the 
demonstration is found in the fact of better health and 
greater longevity of those who keep these covenants 
inviolate. 

It is worthy of remark that marriage at too early an 
age is not conducive to health or longevity, but, on the 
contrary, the mortality among young married persons, 
I mean of married persons under the age of twenty, 
particularly women, is very great. I do not think that 
women ought to marry under twenty -two, or men under 
twenty -five years of age. 

Pregnancy, although not a condition of disease, is one 
of excitement, in which the entire economy more or less 
participates. 

It is interesting to note the considerate kindness with 
which the pregnant female was treated in ancient times. 
Indeed, she became the object of special attention and 
regard. Among the Jews she was, during the period of 
her gestation, permitted to partake of whatever meats 
she desired, no matter how strongly prohibited by the 
Mosaic commandments at any other time. It was a 
recognized custom, too, among the Athenians, to absolve 
from punishment the murderer, whose hands were yet 
wet with the blood of his victim, if he sought shelter in 
the house of a woman carrying her child. 

Signs of Pregnancy. — The changes in the local condi- 
tion of the uterus are promptly followed by more or less 
constitutional excitement. One of the very first organs 
in which this excited action is manifested is the stomach, 
as is shown by the nausea and vomiting which in many 
instances so quickly, and in the great majority of cases 
so generally, supervene upon pregnancy. 



AND GUIDE TO HEALTH. 593 

The Suppression of the Catamenia {or Menses). — A 
popular belief has obtained that when a female becomes 
impregnated she ceases to menstruate during her gesta- 
tion. As a general rule this is undoubtedly true ; but 
there are so many other conditions of the system in 
which this function becomes temporarily arrested that, 
by itself, it is of but little or no value as a sign of preg- 
nancy. A very popular opinion is — and entertained too 
by some medical men — that pregnant women never men- 
struate. This, however, is not a fact. Dr. Bedford, Pro- 
fessor of Obstetrics in the Xew York University, and one 
of the " lights of the age," says, in his " Principles and 
Practice of Obstetrics," a work that I have drawn heavily 
upon in this and other articles, " I have attended a lady 
in this city in four confinements who has not had her 
courses suppressed during any of her pregnancies, and 
who was never positively certain of her condition until 
the period of quickening. Again : It is not uncommon 
for young married women to have a slight show for two 
or three periods after their first impregnation." 

Cessation of the menses may be regarded as a sign of 
pregnancy, but not a positive one. 

Depraved Appetite. — A frequent consequence of im- 
pregnation is a depraved appetite — a longing for unnat- 
ural food — so that some of your patients will consume 
with infinite gusto, chalk, slate pencils and other kindred 
dainties. Some become passionately fond of fruits. I 
knew a case in which the lady exhibited such a passion 
for oranges that the quantity she consumed is almost in- 
credible. I attach more than ordinary importance, as a 
sign of pregnancy, to this depraved appetite, and am 
disposed to regard it, under certain conditions, as quite 
a significant circumstance. For example, if a married 

woman, whose general health has been uniformly good, 
38 



594 THE FAMILY PHYSICIAN 

should suddenly exhibit this morbid taste, I should be 
much inclined to look upon it, all things being equal, as 
strong presumptive evidence of impregnation. 

Change in the Breasts. — As a general rule the breasts 
enlarge. This enlargement is attributable to an afflux of 
fluids that takes place after impregnation at an uncertain 
length of time. It may take place in a week or two 
after fecundation, or not until the third, fifth, or last 
month of gestation. 

Milk in the Breasts. — This is regarded as a very im- 
portant evidence of gestation ; but while it is certainly 
one of the usual accompaniments of pregnancy, it must 
not be forgotten that the secretion of milk may take place 
in various conditions of the system in which impregna- 
tion has not occurred. Milk has sometimes been found 
to secrete in the breasts of virgins and even males ; it 
may be secreted from a diseased condition of the ovaries. 
Cases are not wanting where milk has been secreted in 
the breasts of females who are not 3 and never have been, 
impregnated. 

The womb, from the instant of impregnation until the 
full term of utero-gestation, is constantly undergoing 
changes. I shall not enter into a description of them in 
this work, but the physician places much dependence on 
these signs when it is necessary to ascertain positively 
a case of gestation. 

Quickening. — It will be observed that all the signs I 
have given of pregnancy, so far, have admitted of doubts 
— in fact, all signs are doubtful until the period of 
quickening \ which is about the middle of gestation or 
about four and a half months from conception. The 
first movement of the child in the womb, no matter how 
slight, is the first positive knowledge the mother has that 
she is pregnant ; and while it furnishes her this positive 



AND GUIDE TO HEAL'TH. 595 

knowledge, it at the same time gladdens her heart with 
the knowledge that it is living. It is trne the mother 
who has borne children becomes thoroughly convinced 
before this, time that she is pregnant, from the nausea 
and vomiting which sometimes set in as soon as fecun- 
dation takes place, and from the depraved appetite, which 
are two of the best signs short of quickening, and from 
the cessation of the menses, &c. But she may be mis- 
taken ; cases are not wanting in which all these signs 
have failed. I have not spoken of the change in the 
color of the breasts ; it, like the other signs, is uncertain ;. 
even the plethora that often occurs may be deceptive. 

I have already said that pregnancy was not a patho- 
logical or diseased condition ; but while the fact is con- 
ceded, yet, on the other hand, it is not to be forgotten 
that many of the sympathetic phenomena characteristic 
of gestation will sometimes, through exaggerated action,, 
assume a morbid character, calling for the intervention, 
of science. 

The derangements of pregnancy may be divided into 
physiological and mechanical. A true and complete 
physiological action is nothing more than a natural func- 
tion, and while it keeps within the particular sphere of 
duty assigned to it in the mechanism, it can not, by any 
construction, be denominated morbid. It is only when 
the physiological function ceases to be recognized by 
nature as a sound link in the chain of forces which make 
up the entire working of the system in health that it 
becomes converted into a pathological or diseased result. 

This occurs frequently in pregnancy. For example,, 
there is scarcely a sympathy evoked in the economy as 
the consequence of fecundation which may not in this 
manner become morbid and need the attention of a^ 
practitioner. 



596 THE FAMILY PHYSICIAN 

Again, as the result of mechanical pressure, there may 
occur various phenomena which, from their disturbing 
influences, are entitled to be termed morbid, and which, 
therefore, are legitimate objects of medical treatment. 

The digestive, vascular and nervous systems may all 
become more or less disordered, as incidental to gesta- 
tion, and these derangements will assume various types. 
The nausea and vomiting, ptyalism, depraved appetite, 
constipation, diarrhea, heartburn, plethora, &c, are all 
so many consequences which, under certain circum- 
stances, may require treatment. 

TREATMENT. 

During the period of gestation, if the patient is judi- 
cious in her exercise .careful in her diet, and correct in 
her habits, she \ i equire but little treatment. If she 
will strictly obs; j • < € ordinances of nature which have 
been inculcated for her guidance ; if, for example, she take 
her regular exercise in the open air, avoid, as far as may 
be, all causes of mental or physical excitement, employ 
herself in the ordinary duties of her household, partake 
of nutritious and digestible food, repudiate luxurious 
habits, the exciting accompaniments of the dance, late 
hours, late suppers, &c. ; if she will steadfastly adhere 
to these common sense rules, the reward that she will 
receive at the hands of nature will be, general good 
health during her gestation, and an auspicious delivery, 
resulting in what will most gladden and amply repay her 
for her discretion — the birth of a healthy child, which is 
to constitute both the idol of her heart and the study of 
her life. But if, in lieu of these observances, the preg- 
nant woman pursue a life of luxury, " eat, drink and 
be merry," neglect to take her daily exercise, and 
prefer her lounge, then the case is entirely reversed ; she 



AND GUIDE TO HEALTH. 59/ 

becomes plethoric, and, if not relieved by the employ- 
ment of appropriate remedies, she often dies, having 
blotted herself from life by her own folly. Yon see, 
therefore, that pregnancy per se is not, in reality, a con- 
dition of plethora, bnt becomes so through the violation 
of laws prescribed by nature ; and this is equally true 
with regard to the general health of the female during 
her gravid state. 

Nausea and Vomiting. — It is conceded that nausea 
and vomiting are the usual and, so to speak, the natural 
sympathetic accompaniments of gestation, and, therefore, 
under ordinary circumstances, do not require the atten- 
tion of the physician; but sometimes it may become 
necessary to resort to remedies for the purpose of keep- 
ing them within reasonable limits. Morphine in doses of 
one- sixth or one-fourth, of a grain in a teaspoonful of 
water, or opium in quarter or half grain doses, may be 
given, and will generally give relief. Sometimes small 
pieces of ice swallowed, or a piece of ice laid on the 
stomach, will give relief. A tablespoonful of lemon juice 
in a tablespoonful of water, or the same quantity of lime 
water and milk two or three times a day, will answer the 
same purpose. If the bowels are constipated, which is 
generally the case, a mild cathartic must be given. For 
this purpose ten grains of blue mass may be given at 
night, followed by a Seidlitz powder next morning. 

Ptyalism or Salivation. — This symptom does not often 
occur, but is sometimes an attendant upon pregnancy. 
If the now of saliva is excessive, salts may be taken in 
small doses — one teaspoonful in half a tumbler of water 
every other morning. 

Constipation. — It may safely be affirmed that regu- 
larity of the bowels during gestation is the exception, 
while a tendency to constipation is the general rule. It 



598 THE FAMILY PHYSICIAN 

is very desirable to assist nature during gestation in 
removing the general torpor of the intestinal canal ; for 
if it he permitted to continue, headache, fever and loss 
of appetite will usually ensue. For this purpose a sim- 
ple enema (injection) of warm water early in the morn- 
ing, or, what will frequently answer, a tumbler of cold 
water drank as soon as the patient leaves the bed ; or a 
raw fresh egg well beaten, with a little cold water and 
clarified sugar, drank as soon as the patient rises from 
the bed, will generally answer the purpose. Sometimes 
it will be necessary to use a mild cathartic or some laxa- 
tive medicine. 

DiarrTiea. — Pregnant women are sometimes subject to 
an opposite condition of the bowels, viz. : diarrhea will 
sometimes supervene on pregnancy almost simultaneous 
with it, and sometimes it may be brought about by the 
common causes of diarrhea, such as improper food, cold, 
etc. If this last is the case a good cathartic medicine 
must be administered ; nothing is better than the citra- 
tized magnesia. But if it is dependent on, or an attend- 
ant of, gestation, it must be treated with calming enemata 
or some astringent and anodyne, or Dover's powders in 
three or four grain doses. 

Palpitation of the Heart. — In women of great nervous 
susceptibility palpitation of the heart is not an unusual 
attendant upon pregnancy during the earlier months, 
and if not controlled it may produce miscarriage. If it 
is due to simple nervous irritability, small doses of qui- 
nine—one grain three times a day — with nourishing, 
digestible food, and an anti- spasmodic, thirty or forty 
drops of tincture of hyoscyamus once or twice a day, or 
tincture of valerian, will prove serviceable. If the pal- 
pitation, as is sometimes the case, should be occasioned 
by a plethoric condition of the system, saline cathartics 



AND GUIDE TO HEALTH. 599 

should be used freely and often repeated, with a mod- 
erate diet. Palpitation sometimes occnrs in the last 
months of gestation. This is from mechanical pressure 
of the elevated diaphragm encroaching npon the capacity 
of the chest. Patience is the only remedy for this. The 
"bowels must be kept soluble. 

Fainting. — Yonng married women in their first preg- 
nancy are often subject to fainting. The treatment is 
simple. The patient should be placed instantly in a re- 
cumbent position, her head on a plane with her body, in 
order to facilitate the passage of blood to the brain ; the 
dress loosened, fresh air admitted, cold water dashed in 
the face, and, if necessary, salts of ammonia applied to 
the nose. 

Painful Breasts. — The breasts sometimes become the 
seat of distressing pain. If the bowels are costive give 
salts and apply a liniment of camphorated oil, laudanum 
and sweet oil, or a bread and milk poultice. 

Itching of the Genital Organs. — A most distressing 
itching of the external organs will sometimes manifest 
itself during pregnancy. It sometimes constitutes one of 
the most painful affections with which the female has to 
contend, causing her to literally lacerate the parts by 
constant scratching. Ulceration often results. The fe- 
male, from motives of delicacy, often conceals the fact of 
her sufferings from the physician until it has reached an 
aggravated form. The characteristic of the disease is 
intense itching. When there is no ulceration, saline 
cathartics and a lotion of borate of soda — one ounce to 
one pint of water — may be used. If the parts are ulcer- 
ated they must be touched every three or four days with 
nitrate of silver, the parts to be cleansed well with castile 
soap and water and rest enjoined on the patient. If 
there is much inflammation or heat about the parts apply 



600 THE FAMILY PHYSICIAN 

a bread and milk poultice, and if there is a disagreeable 
odor add to the poultice a little finely powdered charcoal, 
changing the poultice often. An ointment of calomel — 
one drachm to an ounce of lard — is recommended to be 
applied twice a day, after which powder with starch to 
which one-fourth part of camphor has been added. 

Piles. — Piles are not uncommon during pregnancy and 
often give rise to much distress. The remedy is to keep 
the bowels in a soluble condition. This can sometimes 
be done by the administration of a teaspoonful of sulphur 
in a teaspoonful of molasses or honey ; also inject half a 
pint of cold water night and morning into the bowels. 
The patient should always after each evacuation intro- 
duce the protruding piles within the rectum. This she 
can accomplish without difficulty. They should never be 
allowed to remain external. 

Many symptoms will occasionally occur that have not 
been mentioned in the preceding article, but I have tried 
to treat candidly and in plain terms of the most promi- 
nent ones that generally occur; and if others should 
occur examine and see whether they are nervous or have 
arisen from plethora. If nervous, treat with nervines ; 
if plethoric, with saline cathartics. But above all attend 
to the exercise, diet and general habits of the patient ; 
have them correct and there will be but little use for 
medicine. 



AXD GUIDE TO HEALTH. 601 



ABORTION. 



The loss of human life from the prematnre expulsion 
of the fecundated ovule is very great, particularly when 
we take into account the numerous instances in which 
the loss can not Tbe positively ascertained ; such, for ex- 
ample, as in very early pregnancy, when the discharge 
of blood attending the miscarriage is oftentimes judged 
to be nothing more than a late return of the menstrual 
flow. The expulsion of the fecundated ovule from the 
uterus at any period from conception before the termina- 
tion of the sixth month is an abortion, and from the sev- 
enth month prior to the expiration of the ninth month 
premature labor. The period of pregnancy at which 
abortion is most frequent has been a question much dis- 
cussed by medical writers. Madame La Chapelle, of 
Paris, a writer of considerable eminence and one whose 
statements had great weight, has fixed the time at the 
period of six months, which opinion was generally 
adopted. Correct observations, however, prove to the 
contrary. The results of practice will exhibit conclu- 
sively that abortion is most frequent during the earlier 
months, say from the first to third, and the reason for 
this is founded on the fact that at this early period the 
attachments of the embryo to the uterine surface are 
comparatively so friable that they are more liable to be 
broken up, thus ending in the premature expulsion of 
the product of conception. I also think that the primi- 



602 THE FAMILY PHYSICIAN 

para is more disposed to abortion than the female who 
has already borne several children. In the former the 
uterus, for the first time becoming the seat of those rapid 
and extraordinary changes consequent upon impregna- 
tion, will be more likely to awaken, through reflex or 
other influences, irritation calculated to terminate in 
abortion ; and this is particularly observed in two classes 
of patients, presenting two opposite conditions of system, 
viz. : first, in the excessively nervous ; second, in those 
characterized by unusual plethora. 

Causes of Abortion. — It will be a little difficult for a 
person who does not understand reflex movement or 
reflex nervous influences to understand how hemorrhoids, 
a collection of fsecal matter in the rectum, irritation of 
the vagina, &c, will be likely to provoke early action of 
the uterus. An irritation is produced on the peripheral 
or terminal extremity of one or more nerves ; the im- 
pression thus made is conveyed by the nervous trunks 
to the spinal cord and the oblongata, by which, and 
without the interference of mind, an impulse is reflected 
back, through the motor nerves, to certain muscles, and 
hence a movement is produced. This is, physiologi- 
cally, reflex movement. 

Among the causes of abortion from excito-motory 
influence may be enumerated excessive sexual intercourse 
in the newly married. A calculus in the bladder, or 
strangury, also the tenesmus of dysentery, all act 
on the reflex principle. It is on the same principle that 
a piece of ice put into the vagina will often arrest severe 
flooding, and on the same principle that titillating the 
mouth of the uterus with the finger will frequently 
arouse this organ to severe contraction. Women some- 
times soon after parturition experience severe pain in the 



AND GUIDE TO HEALTH. 603 

uterus from the application of the infant to the breast. 
This is reflex influence. 

Suction of the breast is recommended by Scanfoni for 
the purpose of bringing on contraction of the uterus in 
cases in which, from justifiable motives, it becomes 
desirable to induce premature delivery. Lactation or 
nursing is a cause of abortion, and it is important for a 
female who is suckling to wean her child as soon as she 
suspects that she is pregnant. The extraction of a tooth 
will sometimes cause an abortion. 

There is, however, another distinct class of causes 
capable of producing premature contractions of the 
uterus ; and they differ from those already named in the 
important particular that they are centric, that is, their 
influence is exercised primarily on the medulla spinalis 
itself, and not secondarily, as in the case of the operation 
of the eccentric causes, which I have already said is 
through a reflected, and not a direct action. To illus- 
trate : suppose a pregnant woman receive a blow on the 
spine, followed by abortion. Here, then, is an example 
of centric cause, for the reason that its primary influence 
is on that great nervous centre — the medulla spinalis. 
Suppose a pregnant woman, from the application of suc- 
tion to the breast, abort. Then we have an example of 
eccentric cause. The irritation is produced on the nerves, 
conveyed to the medulla oblongata and reflected to 
the uterus, producing the contractions. 

Women who have suffered excessive depletion, either 
from the lancet or the injudicious use of mercury, will 
be subject to miscarriage. I will take the liberty here 
to mention a case, a very interesting one, too, of miscar- 
riage by the use of mercury. A very estimable lady, 
about twenty-four years old, and the wife of one of our 
best citizens, became pregnant for the third time — having 



604 THE FAMILY PHYSICIAN 

previously given birth to two fine healthy children. She 
was laboring under a pulmonary disease, and had been 
for two or three years. I was called to attend her, she 
having been attacked with pleurisy. She recovered from 
the attack very slowly, and finally got able to be up a 
little, but would occasionally relapse. She went on in 
this way until about the end of her fourth month of 
gestation, when her husband, from his great anxiety for 
her recovery, called two other medical men — not men, 
however, of my choice — who examined and were made 
acquainted with the case and its treatment, which 
had been up to that time palliative, as much as could 
well be, with tonics at every opportunity. The main 
object had in view was to conduct the lady to her 
full term of gestation, when I fondly hoped that she 
would give birth to her child, and that her strength 
would rally for a term ; with this object I had done all I 
could to husband her strength. So careful had I been on 
this point that enemas had been resorted to for the pur- 
pose of keeping the bowels open ; good whisky and 
brandy was procured and given her with tonics. 

But the medical gentlemen completed their examina- 
tion, and, to my very great surprise, one of them, during 
our private consultation, proposed to get the patient 
under the influence of mercury, to " push it to salivation." 
At first the other gentleman did not seem to approve the 
course, but, to my surprise and mortification, he, too ? did 
approve it, and no argument that I could use would shake 
their resolution. They were the blind devotees of mer- 
cury, and, notwithstanding I ventured my prognosis that 
the lady would not live ten days under that course, they 
were inexorable. The case was laid before the family, 
and it was decided that they should try the mercury. 
Of course I withdrew from the case. The fatal drug was 



AND GUIDE TO HEALTH. 605 

given. The second or third day ptyalism was produced ; 
the fifth day the lady had an abortion, the foetus living 
twenty-four hours ; and on the seventh day death closed 
the solemn scene by claiming the lady. 

Two more victims were here sacrificed at the shrine of 
mercury. Two more souls in one week were launched 
into eternity by the injudicious use of mercury. Oh! 
could the silent graves open and give up the victims of 
that drug, and were they enabled to speak, they would 
write one of the darkest pages in the world's history. It 
has perhaps destroyed more fcetal life than any other 
agent, while its victims of more mature years are named 
legion. Pregnant women had better avoid it. Many 
persons will recollect the above case, for in this lady 
society lost one of its brightest ornaments. Mercury in 
the hands of the scientific man is a great and powerful 
agent ; but in the hands of the careless, routine, or heroic 
practitioner, a dangerous weapon of death. 

Mental emotions, whether fright, anger, depression, 
sudden and excessive joy, etc., are all so many circum- 
stances capable of giving rise to abortion, and the influ- 
ence of these may be said to be through centric action. 

Otlier Causes of Abortion. — Plethora often induces 
premature action on the gravid uterus. The abuse of 
amenagogue medicines or a syphilitic taint may cause 
abortion. Death of the foetus, no matter how produced, 
is to be regarded as one of the most certain of all the 
causes of abortion ; and with a moment's thought you 
will perceive how fortunate this provision is, for the con- 
tinued sojourn of the embryo in utero, after its death, 
would necessarily involve, through its decomposition, 
the safety of the mother, and. hence the necessity for its 
early ejection. 

Habitual Abortion. — Some women abort several times 



606 THE FAMILY PHYSICIAN 

successively, and this is called the abortion of habit. 
Women who have miscarried once must use great care 
in subsequent pregnancies. It is well for them, after fe- 
cundation has taken place, not to indulge in sexual inter- 
course until after the fifth month, after which time the 
chances of abortion will be much diminished, avoiding 
at the same time all other causes calculated to excite 
premature action of the uterus. 

Symptoms of Abortion. — These may be embraced in 
two terms— pain and hemorrhage. 

Treatment of Abortion. — The first duty is to prevent 
if possible the abortion. If this can not be done, the next 
duty is to try to conduct the patient safely through it. 
It is rather a nice point to determine at what stage it is 
possible to prevent an abortion. The first thing that 
is to be done is to enjoin absolute rest upon the 
patient, in a recumbent position, with her hips slightly 
elevated. If a portion of the ovum has been thrown off, 
as is often the case, or when upon examination the ovum 
can be felt protruding through the dilated os or out of 
the mouth of the womb, it will be useless to try to pre- 
vent an abortion ; or if the hemorrhage is very great, 
such as to endanger the life of the mother, all thought 
of the foetus must be abandoned at once and measures 
taken to facilitate the expulsion. If, however, there is 
only pain and a moderate degree of hemorrhage, it is the 
duty of the practitioner to try faithfully and promptly 
to prevent it. For this purpose a lemonade may first be 
given, or other acidulated drink, and a solution of sugar 
of lead twenty grains, laudanum two teaspoonfuls, and 
water four ounces; give one tablespoonful every three 
hours. Cloths wrung out of cold water (ice water) may 
be applied on the back, from the loins down, and upon 
the genital organ. Cold is an efficient article to produce, 



AND GUIDE TO HEALTH. 607 

directly and locally, and indirectly at a distance, by a 
reflex action, contractions of the blood vessels : in this 
way it will often arrest the hemorrhage. If the patient 
is plethoric it is recommended by excellent anthors to 
bleed to the amonnt of fonr, six or even eight ounces. I 
have, however, never had recourse to this practice. It 
will be well, though, to administer a saline cathartic and 
to give ten grains of nitrate of potassa in a tumbler of 
water, with five or six drops of tincture of digitalis, re- 
peated every four or six hours until a marked effect is 
had upon the pulse ; then stop it. If the patient be not 
laboring under plethora, but nervous, a different course 
must be pursued — you must calm and fortify the system. 
An injection of thirty drops of laudanum in two ounces 
of water may be thrown into the rectum, and one-fourth 
of a grain of morphine taken internally every three or 
four hours. The lower bowels should be evacuated be- 
fore this by means of an injection for the purpose. And 
if the patient has piles it should be seen that they are 
not allowed to protrude on the outside. 

The treatment we have thus far presented in abortion 
is intended for its prevention when it is merely threat- 
ened. I shall now call your attention to the remedies 
indicated when it becomes impossible to arrest the ex- 
pulsion of the ovum, and in which the duty will be lim- 
ited to saving the life of the mother. The true danger 
in abortion is the fearful hemorrhage. If the uterus is 
sufficiently dilated to permit the introduction of the 
finger, introduce it and press the finger backward and 
forward ; this very motion of the finger evokes a strong 
reflex action, which often results in the prompt expulsion 
of the ovum. If the uterus has not dilated and the hemor- 
rhage is great, the remedies are — cold, the tampon and 
ergot. By dashing ice water on the abdomen it will 



608 THE FAMILY PHYSICIAN 

often cause a prompt action of the uterus, or a piece of 
ice introduced into the vagina will often act like a charm ; 
in either case the uterus is made to contract in conse- 
quence of reflex action. Or the tampon may "be applied ; 
pieces of sponge or lint maybe introduced into the vagina 
until it is filled completely up to the uterus ; the whole 
may be kept in place by a bandage. This must not re- 
main longer at one time in the vagina than four hours. 
This will arrest the hemorrhage and by its irritation 
cause contractions of the womb. The other means spoken 
of is ergot, which produces contraction of the blood ves- 
sels, and also the contraction of the womb ; consequently 
it is a valuable remedy in this condition. If the ovum 
is partly protruding out of the womb, it may be expelled 
by introducing the finger and making gentle traction. 

The patient, after abortion or labor, should be kept 
quiet, her diet light and bowels soluble. If there is 
great prostration from loss of blood, a half teaspoonful of 
laudanum and a teaspoonful of brandy in half a cup of 
strong coffee must be given, and repeated if necessary, 
diminishing the dose of laudanum. 



AND GUIDE TO HEALTH. 609 



LABOR OR CHILD-BIRTH. 



At the lapse of about two hundred and seventy-live 
days after fecundation or conception the foetus becomes 
properly developed and is capable of an external exist- 
ence, or an existence independent of the mother. In the 
divine and wise arrangements of nature the womb con- 
tracts, or commences a series of contractions that culmi- 
nate in the expulsion of the child; this is called" labor." 
Slight contractions are sometimes felt in the uterus for 
two or three weeks before labor really commences. This 
sometimes gives rise to uneasiness or fears in the minds 
of those experiencing them. Such fears are groundless ; 
for observation has shown that there is less fatality in 
them, and in fact in all slow and what may be termed 
tedious cases, than there is in the quick ones. 

I have stated above that about two hundred and seven- 
ty-five days after conception labor may be expected. By 
this I do not wish to be understood to say that this period 
is the definite and fixed duration or full term of preg- 
nancy; for certainly, if there is any truth in statistics, 
the child may be carried for a much longer time, or it 
may be expelled a fully developed child at a much earlier 
period ; but this term is fixed by some writers as an 
average term, and will be found to be as nearly the time 
as can well be fixed. It is difficult to ascertain the exact 
time at which conception takes place. An opinion has 

long prevailed among women that they could tell the 
39 



610 THE FAMILY PHYSICIAN 

exact moment of fecundation by a strange and indescrib- 
able feeling. That this may be true in some cases I will 
not deny ; but in all, or even in any considerable number, 
I do deny most positively. 

It is a well known fact that women often become im- 
pregnated when they are as cold and passionless almost 
as the bed on which they are lying, while others enjoy 
that peculiar pleasurable sensation very frequently and 
do not become impregnated at all. Women generally 
count from the last menstrual now, but this is very uncer- 
tain, for while a woman is more liable to become preg- 
nant just before a menstrual flow than at any other time, 
because the ovule is always present and ripe, if I may be 
allowed the expression, just at the time of the catamenia ; 
but while this is true, it is also true that she may be im- 
pregnated at any time between the menstrual periods ; 
consequently there is a term of almost four weeks that it 
may vary. 

Professor Bedford, in his " Obstetrics," gives a rule that 
he finds to work well. He says : " Imagine, for example, 
the termination of the last menstrual to be on the tenth 
day of January ; then count back three months, which 
will correspond with the tenth day of October ; now, to 
the tenth of October add seven days ; this will bring you 
to the seventeenth day of October, the day on which the 
labor will commence." 

Symptoms of Labor. — The main and characteristic 
signs of labor are four in number : the first of which is 
pain ; the second is dilation of the mouth of the womb ; 
the third is a mucous discharge; and the fourth the 
formation and rupture of the membranous sac, or " bag 
of waters." These four constitute the elements and 
make up the diagnosis of labor. When they are pre- 
sent, labor is undoubtedly in progress. It is necessary 



AND GUIDE TO HEALTH. 611 

to discriminate between what is termed " true " and 
" false " pain. It is only necessary to mention that true 
pain is the effect of uterine contractions, and that false 
pain is not, but may be produced by a great many 
causes, and is generally continuous, while the true pains 
caused by the contractions of the womb are periodical, 
and during the interval between them the patient is easy 
and often converses cheerfully. Pain is the inevitable 
penalty of child-birth. It is one of the penalties fixed 
by the unalterable decree of Jehovah upon woman for 
the disobedience of the mother of all in the beautiful 
garden of Eden. 

" Unto the woman He said, I will greatly multiply thy 
sorrow and thy conception; in sorrow thou shalt bring 
forth children; and thy desire shall be to thy husband,, 
and he shall rule over thee." 

The pains at first are usually slight ; they are first felt; 
in the back, and usually pass on to the thighs. The^ 
are not continuous, but come on at intervals. When th@- 
true pain is present, the entire era of the womb becomes 
hard; and this change in its condition can readily be 
recognized by placing your hand on the abdomen. 

Dilation of the os uteri or mouth of the womb. — If, 
upon examination, the womb is found to be dilated, 
and during a pain the membranous sac, or "bag of 
waters," is felt to protrude, and there is a free mucous 
discharge, it may be a certainty that labor has com- 
menced. 

Natural Labor. — If, upon examination, it is found that 
the vertex, or crown of the head, face, the breech, feet or 
knees, present, it may be considered natural labor. lm 
either of these presentations, if there arise nothing to- 
complicate the delivery, nature can, by her own re- 
sources, accomplish the expulsion of the child. As soon 



612 THE FAMILY PHYSICIAN 

as labor has commenced, the next care is to conduct the 
patient through it safely. If the bowels have not been 
evacuated for a day or more, and especially if there be 
fsecal matter in the rectum, it is quite essential that an 
enema (injection) should be administered, or a dose of 
castor oil, if preferred ; and, also, if there be an accumu- 
lation of urine in the bladder, the patient should be 
directed to relieve herself by passing it off. 

Quietude in the Room. — This should be earnestly 
urged. The patient should be kept quiet, with as little 
noise and disturbance in the room as possible. Let her 
be saved the perils of excitement from the presence of 
persons who can render no assistance, but who contami- 
nate the air and by their frivolous conversation disturb 
the patient. I know from long experience in such cases 
that it is the custom of women to gather in great numbers 
on such occasions, and with the kindest intentions, all 
willing and anxious to render assistance to the sufferer ; 
but such gatherings are generally a disadvantage to the 
patient, for whoever has witnessed a gathering of this 
kind can readily testify to the fact that a vast amount of 
noise and confusion is sure to prevail ; and it is very often 
the case that some one of the party, less discreet than 
the others, will recite what she has seen or heard of in 
the lying-in chamber of an unpleasant and frightful 
character. By such recitals the mind of the patient is 
filled, with terror, and great harm may result from it ; or, 
as I have frequently witnessed, the patient may be much 
annoyed by untimely jokes and unnecessary questions, 
or may be much alarmed by a disagreeable habit some 
women have of whispering their fears about her safety 
or that of the child. It is always better if there is much 
company to have them stay in a separate room, and only 
allow two or three at farthest in the room with the 



AND GUIDE TO HEALTH. 613 

patient. This number includes the one who officiates or 
attends the case. This can be performed by any woman 
of ordinary sense, who will spend a little time in studying 
the rules which are laid down in this book. It is natural 
that women should attend these cases ; every feeling of 
refinement and modesty demands it; in fact, common 
decency cries aloud for it. It can be done by women as 
well as by men. Nature left to herself will accomplish the 
work in due time and in safety. There are more lives 
lost by meddlesome midwifery than are saved by all the 
assistance that has ever been given by science. In nine- 
teen cases out of twenty there is simply nothing to do 
but wait for nature to perform the work. It is true there 
are occasionally cases of preternatural labor, in which 
assistance is necessary, but even in these the female who 
has been properly educated in this branch can render 
that assistance. 

There is now a growing and commendable desire 
among intelligent females to become acquainted with the 
diseases and their treatment peculiar to themselves at 
least. This should be encouraged and every facility 
given them, until it shall no longer be necessary for them 
to undergo the humiliation and exposure of laying their 
case in detail before a physician. I confidently hope, in 
the progress that marks everything in the present age, 
that the time is not far distant when the science of med- 
icine will be taught and become as much a part of an 
education as mathematics or English grammar is now — 
when it will be disrobed of its present mantle of techni- 
calities and clothed with plain English. When this is 
the case it will be as easily understood and as readily 
comprehended as any of the ordinary sciences. 

Impropriety of Frequent Examinations. — It is im- 
proper during the first stage of labor to be frequently 



614 THE FAMILY PHYSICIAN 

introducing the finger into the vagina. It is annoying 
and injurious to the patient. After you have satisfied 
yourself as far as may he of the true state of things by 
the examination at the commencement of labor, there 
can be no necessity for more than one or two repetitions 
until after the escape of the waters, when it again be- 
comes necessary to explore and inform yourself as to the 
progress of delivery and the precise position of the pre- 
senting part. The patient should be allowed some bland 
nourishment, such as tea, gruel, etc. ; but not wine or 
spirits, unless specially indicated. 

Stages of Labor. — In order to simplify the matter, we 
will divide labor into three stages : the first will consist 
in the full dilatation of the womb and rupture of the bag 
of waters ; the second stage, the descent and expulsion 
of the child ; the third, the delivery of the placenta 
(after-birth). During the commencement of the first 
stage the pains are slight, passing from the back to the 
thighs, and are called grinding. It is not until the womb 
is dilated and the membranous sac and presenting por- 
tions of the child begin to make a decided pressure upon 
it that the pains assume a strongly marked bearing down 
character. Before this time it is not necessary to urge 
the patient to " bear down," as it is termed; if you do 
she only wastes strength that she will likely need before 
she is through ; but at this period she can much aid them 
and facilitate labor by "bearing down." 

Position during Labor. — It is a great mistake, before 
the rupture of the sac of waters, to confine the patient in 
any particular position. She may be allowed to sit up, 
walk, recline, or, in fact, do as she pleases. The broadest 
latitude may be given her. But after the rupture of the 
sac it will be prudent for her to remain in bed. She 
should then take a position lying on her back. 



AND GUIDE TO HEALTH. 615 

Rapture of Sac of Waters. — As a general principle, 
when the womb has become sufficiently dilated to enable 
the head of the child to pass, there is a spontaneous rup- 
ture of the sac, followed by an escape of more or less of 
the amniotic fluid (waters). Care should be taken not 
to rupture the sac prematurely ; the result would be a 
more protracted delivery and sometimes an injury to 
both mother and child. There are cases in which it may 
be necessary to rupture the sac early in labor ; that is 
when it is extremely rapid from the commencement and 
you fear a too quick expulsion of the child, with its an- 
nexse. The too rapid evacuation of the contents of the 
womb might throw that organ into a state of inertia, which 
would give rise to great hemorrhage and endanger life ; 
but these cases are rare. 

Second Stage of Labor. — The second stage of labor 
commences when the membranous sac has ruptured and 
the waters or a portion of them escaped; the contrac- 
tions of the uterus increase in violence and become 
decidedly expulsive. It will be well now to make an 
examination to ascertain the state of things with regard 
to the true position of the child and its progress. You 
must now have in readiness a piece of tape, or a string 
made by doubling together about four strands of common 
cotton thread — a piece of tape is much better and should 
always be used — you must also have in readiness a pair 
of scissors to cut the navel cord with, after it has been 
tied about two inches from the body of the child. It 
will be well now to attach a sheet to the foot of the bed 
that the patient may grasp it with her hands, and with 
her feet well braced she should pull gently, and be 
directed to bear down and assist nature. It is during 
this stage that the patient will complain of great pain in 
the back. As the head of the child approaches the 



616 THE FAMILY PHYSICIAN 

vulva, or external parts, the patient will feel an urgent 
desire to evacuate the Ibowels, and will want to leave the 
"bed for that purpose. This she must not do, for, at this 
advanced stage it would endanger the life of both the 
mother and child. The desire is caused by the pressure 
of the head of the child against the rectum. The head 
having approached the external opening, the perineum 
(that part that is between the anus and vagina) becomes 
extraordinarily distended and must be supported or it 
might become ruptured ; this support can be given by 
taking a piece of linen, folded in the hollow of your 
hand, in order to constitute it a plane surface, and make 
during the pains a firm and equable pressure on the peri- 
neum, being careful not to press directly against the 
head of the child so as to retard its progress. In the last 
struggles, just about the time the head is making its 
appearance into the world, the patient will sometimes be 
attacked with nervous tremblings. They are of no sort 
of importance, and need give rise to no disquietude. 
When the head has thus escaped there is experienced 
great relief. The first care now is to see if the cord 
encircles the neck of the child. If it does, and is tight, 
you should relax it so that it may be gently drawn over 
the head ; if it is very loose around the neck, you need 
not trouble it, unless it can be very easily removed. It 
is well also to introduce the finger into the child's mouth 
and remove any phlegm or mucous that is in it. The 
child will generally then be found to gasp and give evi- 
dence that it is alive. The next pain will generally expel 
the body ; when it must be laid near the vulva, with its 
back to the mother. The child will generally be heard 
to cry, which is conclusive evidence of respiratory action, 
and you may now proceed to tie a piece of tape around 
the cord, about two inches from the body, after which 



AND GUIDE TO HEALTH. 617 

you must cut the cord a little iu front of the ligature. It 
is the custom of some to tie two ligatures and cut the cord 
between them, and urge the necessity of this to prevent 
hemorrhage, but I can see no force in this argument, for 
there is no way for hemorrhage to come from the patient 
through this cord at this time ; the second ligature, how- 
ever, can do no harm and may be applied. The child 
may then be removed to a blanket, previously warmed 
and prepared for this purpose, when it may be washed 
and dressed in the ordinary manner. 

Third Stage of Labor. — This consists in the expulsion 
of the placenta, or after-birth. As soon as the child has 
been expelled, place your hand on the abdomen imme- 
diately over the womb, for the purpose of being assured 
that the womb responds to the birth. The evidence of 
this response will be, that you will feel the organ gath- 
ered, as it were, upon itself, occupying the lower portion 
of the abdominal cavity, and presenting the feeling of a 
hard, contracted object. In the recognition of this cir- 
cumstance your mind is at ease with regard to the fear 
of flooding. Suppose, on the contrary, instead of this 
contracted condition of the uterus you should find the 
organ uncontracted and in a state of inertia, occupying 
more or less of the abdomen. This state of things would 
at once admonish you of the certainty of flooding / and 
being thus admonished you must lose no time in staying 
the current, which if not promptly checked will destroy 
the life of the patient. 

Flooding is the great danger to which lying-in women 
are exposed, and a circumstance, therefore, that demands 
the prompt attention of the attendant. From a little 
indecision or neglect here the patient is lost. The flood- 
gate is opened and the life-current will flow out in a very 
few minutes. There is no time for consultation now — 



618 THE FAMILY PHYSICIAN 

no time for the perusal of books to see what shall be 
done. That inexorable enemy, Death, is pressing for his 
victim, and but for the prompt interposition of science, 
the chamber of sickness will be converted into the gloom 
of desolation and heart- stricken grief. 

But in this emergency the female attendant may not 
despair ; she can be equal to the emergency. She can here 
grapple with the monster, Death, and wrest from him his 
victim. It is only necessary for her to know her duty 
and perform it, which she can do as well as the physician, 
and much better than hundreds of them do. 

It is necessary to know what the cause of flooding is. 
This is easily understood ; there can be no mistake about 
it. When a woman has profuse flooding after the expul- 
sion of a child from the uterus, it is because this organ 
is in a state of relaxation — a state known as inertia. If 
the womb contracts flooding can not take place. Just 
as soon as this organ can be made to contract, all fears 
of flooding may cease; then the great object will be to 
cause the womb to contract as speedily as possible. I 
will assert here that for this purpose no internal remedy 
will do to depend upon. Ergot will not produce con- 
tractions of the womb under fifteen or twenty minutes, 
and before this time the patient will be dead. The tam- 
pon has been often used, but it is worse than useless in 
a flooding of this kind. It is the practice of some to re- 
move the placenta or after-birth ; but this does not afford 
relief, and for many reasons is a bad practice. The only 
means that can be confidently relied upon are pressure and 
cold. " Remember," says Dr. Bedford, " there is no time 
for compromise, no time for capitulation ; the enemy, with 
bold front and intent upon destruction, has laid his grasp 
upon the victim and the issue of life or death will be de- 
termined by the promptness and character of the resist- 



AND GUIDE TO HEALTH. 619 

ance. Therefore what yon are to do in the management 
of hemorrhage (flooding) is this — introduce your hand, 
without a moment's delay, into the nterns, carry it np to 
that portion of the organ to which the placenta is par- 
tially attached or from which it has been completely 
separated ; with the expanded dorsum (back) of the 
fingers make gentle but uniform pressure against the 
bleeding utero placental vessels, and, with the other 
hand applied to the abdomen, make counter pressure. 
Should the womb not contract, have recourse immedi- 
ately to the cold dash. Let a pitcher of ice water be 
thrown from a hight — say two feet — suddenly and with 
impulse upon the abdomen, and repeat it without hesita- 
tion should it be necessary. Such are the heroic, sub- 
stantial and common sense remedies in these cases of 
desperate hope, and they will often ser^e you faithfully 
in the hour of need. As soon as the uterus begins to 
contract gather up the after-birth in your hand, should 
it be within the organ, and keep it firmly in your grasp 
until, by powerful contractions, it, together with the hand, 
is expelled. Striking benefits will be derived from the 
introduction of a small piece of ice into the vagina or 
uterus — the contact of cold thus suddenly applied will 
oftentimes occasion immediate contraction of the organ 
by the stimulus applied to the excitor nerves of the part, 
inducing the full influence of reflex movement. Injections 
of ice water into the rectum will also act powerfully upon 
the uterus through reflex agency. Ice water as a drink 
will occasionally display great efficacy in uterine inertia, 
causing contraction of the organ, through its impression 
on the pneumogastric nerve, which is also an excitor of 
the uterus." 

The pressure and cold are the great remedies in this 
flooding, and if properly carried out will prove efficient. 



620 THE FAMILY PHYSICIAN 

"When it has become necessary to use cold to arrest flood- 
ing, it will be necessary the moment the nterine contrac- 
tions take place to apply warmth by means of bottles of 
warm water, warm flannels, etc. In doing this the patient 
is not to be moved, for the slightest exertion would be 
likely to produce fainting. The patient must not for a 
considerable time assume the upright or sitting posture ; 
it may cause sudden death. After the flooding has ceased 
the patient may still sink and exhibit the aspect of a 
moribund woman — deadly pallor of countenance, cold 
surface, no pulse to be detected in the wrist or temples. 
In these cases, which so closely assimilate dissolution, 
there is no time to be lost ; you must give her stimu- 
lants, such as brandy, strong coffee, with twenty or thirty 
drops of laudanum ; care must be taken, however, in 
their administration. When reaction is established the 
strength must be sustained by animal broths, arrow root, 
jellies, &c. 

Internal hemorrhage must be treated precisely as ex- 
ternal. No attention must be paid to the clots of blood 
or the discharged placenta, but the hand should be intro- 
duced, as before directed, and pressure made against the 
bleeding surface. Contraction of the womb is the great 
object; if this is accomplished the patient lives, if it is 
not she dies — there is no help for her. Expulsion of the 
placenta is a normal condition of things preceded by the 
detachment from the uterns. This detachment is accom- 
plished by the contractions of the womb in from five to 
twenty minutes. Ordinarily the patient will have pain, 
which will be followed by a slight discharge of blood. 
These are the evidences that the placenta is disengaged. 
After the placenta has become detached from the uterus 
and the organ contracted, and nature does not expel the 
after-birth, it may be removed easily by taking hold of 



AND GUIDE TO HEALTH. 621 

the cord and making two or three twists of it around two 
of the lingers of one hand, pulling gently, making trac- 
tion up and down, right and left — not abruptly, for the 
cord might break, but gently and firmly. Its delivery will 
readily be accomplished in this manner. 

A bandage twelve or fourteen inches wide should then 
be placed around the patient, making slight pressure 
on the abdomen and over the womb. Two or three hours 
afterward the stains and blood should be sponged off 
with warm water, the soiled linen removed and the 
patient placed comfortably in bed. Another chapter 
will be devoted to her further care and that of her child. 



SECONDARY FLOODING. 



A flooding may occur at any time after delivery, from 
two hours to two or three weeks. This form of hemor- 
rhage is called secondary hemorrhage. 

It will generally be traceable to some portion of the 
membranes, after-birth, or coagulated blood having been 
retained in the uterus. If this is the case, the substance 
must be removed at once, and the flooding will usually 
cease. The bleeding may be the result of a partially 
flaccid state of the uterus, not amounting to inertia. If 
this be the case, ergot may be administered with confi- 
dence ; it will bring on contractions of the womb. In 
connection with the ergot, a half pint of cold water may 
be injected into the rectum. Sometimes in plethoric 
women the bleeding will be due to congestion of the 
uterus, in which case a free dose of epsom salts or 
Seidlitz's powders must be given, and the patient kept on 
strictly abstemious diet. 



622 THE FAMILY PHYSICIAN 



MANAGEMENT OF THE WOMAN AFTER LABOR. 



After the placenta (or after-birth) has been delivered, 
a napkin should be warmed and placed to the vulva, or 
the external parts of the organs of generation, to protect 
the patient against the discharge which, in more or less 
quantity, will necessarily pass from the uterus. This 
napkin should occasionally be examined to see if there 
is from any cause too much oozing or hemorrhage. Pre- 
vious to this, however, the abdominal bandage should be 
applied. This bandage should consist of a strip of linen 
or cotton cloth, folded once, and about twelve or fourteen 
inches wide ; sufficiently long to encircle the body. The 
object of applying it is to afford gentle and equable 
support to the abdomen, which has been in a state of 
great distention; and, now that the child has left the 
uterus, it is, on the contrary, in a remarkably relaxed 
condition. The patient should not be permitted to make 
the slightest effort in the arrangement of the bandage. 
It should be passed under her next to the skin, and 
arranged so as to come well down over her hips. It must 
not be drawn too tight ; if it is there is danger of pro- 
ducing inflammation of the womb of the most stubborn 
character ; it must be drawn so as to produce gentle 
pressure and support, and then attached with pins. The 
patient should now be permitted to rest quietly for two 
or three hours, when the stains and clots of blood may 
be washed off with a sponge or cloth, wet in warm water, 
and dry, clean clothing put on her, and the bed clothes 



AND GUIDE TO HEALTH. 623 

changed, at least all of them that are wet and soiled. 
During all this the patient must remain in a recumbent 
position, and not exert herself in any way ; she must 
now remain quiet, and sleep if possible. No wines or 
toddies or other stimulants must be allowed her, unless 
there is something to indicate their use. A cup of tea 
or some warm gruel may be given her if she desires it, 
and then leave her to quiet repose ; it is what she most 
needs. 

After-Pains. — These pains are nothing more than the 
contractions of the uterus ridding itself of the fluids 
contained within it, and, at the same time, through these 
contractions, gradually returning, as it were, to its 
pristine state. After-pains are, therefore, not morbid, 
but may be classed among the usual and necessary 
phenomena of child-birth. 

In a woman with her first child (a primipara) these 
pains are ordinarily slight ; in (a multipara) a woman 
who has borne children, on the contrary, they are often 
severe and harassing. If they become very annoying it 
may be necessary to give a Dover's powder of five or six 
grains occasionally ; but unless they are quite annoying 
and prevent sleep it will not be necessary to interfere 
with the natural process. The patient should use a bed 
pan and not be allowed to sit on a pot, for a few days at 
least ; this may seem a little inconvenient, but she will 
be amply repaid for it by an immunity from such acci- 
dents as prolapsus uteri or providentia of the organ, or 
prolapsus of the vagina. If in twelve or fifteen hours 
the patient can not pass her urine and the bladder is 
distended, as may be ascertained by feeling, cloths wet 
in warm water may be applied to the genital organs 
and over the region of the bladder ; if this course does 
not soon give relief by the patient passing off the urine, 



624 THE FAMILY PHYSICIAN 

a female catheter must be introduced and the water 
drawn off. 

If the bowels of the patient have been neglected, as 
most women are in the habit of doing at all times, and 
particularly during the last months of gestation — a thing 
very detrimental to their health — the lower bowels will 
be loaded with fcecal matter and cause great distress and 
much harm if not removed. For this purpose an injec- 
tion must be used, composed of a pint of soapsuds, an 
ounce of castor oil, four tablespoonfuls of molasses and 
one of table salt. This must be thrown into the rectum 
and will soon give relief. If the lower bowels are not in 
this loaded condition, and have been moved just before 
confinement, it will not be necessary to interfere with 
them until about the third day, when a laxative of castor 
oil or salts should be given and an action produced. The 
patient ought by all means to retain her recumbent pos- 
ture for at least ten days. I know it is hard to keep some 
women from getting up earlier, but they incur great risk, 
and hundreds and thousands lose their health and lives 
by it. 

The patient's diet should be light, consisting of tea and 
toast (not buttered), or gruel, boiled rice, or soft-boiled 
eggs, etc., for at least five days. If everything goes on 
well she may then gradually resume her regular diet. 
"When she begins to nurse it sometimes happens that the 
nipples get very sore and become a source of great annoy- 
ance. When the nipple is fissured or has small cracks 
in it, a solution of nitrate of silver, five grains in an 
ounce of rain water, will be useful ; wet the parts several 
times during the day, but be careful to wash it off before 
allowing the child to nurse. When there are no fissures 
a little borax and water, or two or three grains of sul- 



AND GUIDE TO HEALTH. 625 

phate of zinc to an ounce of water, applied several times 
a day, will soon give relief. 

Draw the Breasts. — If the breasts are not kept properly 
drawn and milk is left in them, the milk ducts become 
greatly distended and inflammation ensues, which, if not 
promptly arrested, terminates in suppuration. If the 
child is not able to disgorge the breasts get a young pup 5 
which is much better than any machine I ever saw for 
that purpose. The moment inflammation of the breast 
is noticed fomentations of hops or other bitter herbs and 
poultices must be applied, giving the patient some of the 
saline cathartics — salts, citratized magnesia or Seidlitz 
powders. If pus forms the breast must be opened. 
This distressing complaint will not often occur if the- 
breasts be kept well drawn. 

Management of the New-born Child. — The first thing 
to be done for the little stranger is a thorough washing. 
The surface of the new-born infant's body is usually cov- 
ered with an unctious or sebaceous material, and in order 
to have this properly removed it will be necessary before 
using the soap and water to rub the entire surface gently 
with sweet oil, or, what will answer the same purpose, 
the yolk of a raw egg. Then warm water and castile 
soap may be applied by means of a sponge or soft 
flannel. The soap should not be allowed to come in con- 
tact with the infant's eyes ; if it does it is likely to cause 
that annoying and often dangerous complaint, purulent 
ophthalmia. When the washing is done the skin should 
be dried with a warm, soft linen cloth. 

The next object is the dressing of the cord. Take a 

a piece of linen about three inches square, double it and 

cut a hole in the center, through which the cord is to be 

drawn. The cord is then enveloped in the linen, turned 

upward and to the left on the abdomen. A circular band 
40 



626 THE FAMILY PHYSICIAN 

is applied, which will retain the dressing in its place and 
also afford comfortable snpport to the child. Care mnst 
he taken that the bandage be not too tight. Pins should 
not be used for the fastening ; a stitch with a needle and 
thread is much preferable, as the pins may stick the 
child and cause serious trouble. The child may then be 
dressed. 

The practice obtains too generally of cramming the 
child's stomach with castor oil, teas, butter and sugar. 
The best ^ule is to give the child nothing, for the simple 
reason that it needs nothing but the material that nature 
has so carefully prepared for it, and that material is the 
mother's milk. As soon, therefore, as the mother has 
had her repose and rested from the fatigues of labor, say 
in two or three hours, the child should be put to the 
breast. There may be no milk in the breast, but the 
early application of the child is one of the best promoters 
of the milk secretions ; the traction made upon the nipple 
invites the milk to the breasts, and the child at this early 
period extracts what is known as the colastrum, an ele- 
ment that possesses purgative qualities, and which readily 
and effectually removes from the intestinal canal a black, 
viscid material found in greater or less quantities in the 
bowels of the new-born infant. In contemplating these 
things how often we are led to exclaim, how wonderful 
and how perfect are tlie arrangements and provisions of 
nature ! But why should they not be ? for God in His 
divine wisdom ordered them. Truly, indeed, it is a fool 
who says in his heart, there is no God. 

If the child is unable to get any milk from the parent, 
you must give it a teaspoonful of olive oil or a little 
brown sugar and water, or equal parts of water and mo- 
lasses. This will move its bowels ; and if still unable to 
get any milk from the parent, it must be fed on cow's 



AND GUIDE TO HEALTH. 627 

milk diluted with water. This approaches more nearly 
to its natural food than anything else. 

Flat Nipples. — If the mother's nipples are flat so the 
child can not get hold of them, the difficulty may be 
remedied by taking a pint bottle with a long neck and 
filling it with hot water and then pour the water out and 
apply the bottle over the nipple ; as the bottle cools there 
is a tendency to a vacuum, and thus a powerful but 
equable suction is produced, which results in the elonga- 
tion of the nipple. The bottle is then removed and the 
child applied. 



PUERPERAL C0NVULS10IS. 



Puerperal convulsions is one of the most formidable 
and perilous complications of gestation and labor. They 
may appear during pregnancy, at the time of labor, or 
after delivery. Under any circumstances their presence 
is fraught with danger. 

The convulsions are produced by nervous irritability, 
and that of the spinal cord ; this irritation must be had 
by either centric or eccentric action or causes. An in- 
fluence applied directly to that nervous centre is centric ; 
an eccentric cause is an irritation produced on the peri- 
pheral of one or more nerves, and the impression thus 
made is conveyed by the nervous trunks to the spinal 
cord; the impression, altogether independent of mind, 
becomes a sensation which results in a matter of im- 
pulse ; this latter is transmitted to certain muscles, and 
hence an abnormal movement of these muscles is the 



628 THE FAMILY PHYSICIAN 

result. This is reflex action. Flourens has demonstrated 
that muscular action can not be produced by irritation, 
either of the cerebrum or cerebellum, or purely cerebral 
nerves, if the irritation be strictly confined to these por- 
tions of the nervous mass ; and he has further shown 
that muscular movement is the product of irritation — 
either direct or indirect — of the true spinal cord. Now, 
the eccentric causes are, indigestible food in the stomach, 
morbid matter of any description in the intestines, irri- 
tation of the bladder or rectum, or irritation of the 
uterus or the vagina. The centric causes may be, plethora, 
congestion of the spinal cord, or congestion or vascular 
fullness of the brain and spinal cord. 

By keeping these facts before us it does seem to me 
that it will not be hard for us to arrive at the true cause 
of the convulsions in any case ; and, when we fully 
understand the cause, it will certainly not be, in most 
cases, a difficult matter to remove it. That we may 
understand this matter, I repeat, the cause is nervous 
irritation, either centric or eccentric. If the irritation is 
of the stomach, bowels, bladder, rectum, uterus or 
vagina, it is eccentric, being produced on the peripheral 
extremity of nerves and conveyed along their trunks to 
the spinal cord, and results in a motor impulse, which 
is transmitted to certain muscles producing the abnormal 
movement or convulsion. If by plethora, a vascular 
fullness or congestion of the brain and spinal cord, or 
the spinal cord alone, is produced, it is centric. Also, 
the emotions, such as grief or joy, and an ansemic con- 
dition of the system — from these there ma,y sometimes 
come puerperal convulsions, but rarely. They may be 
enumerated among the centric causes. 

Symptoms of convulsions are : the face becomes sud- 
denly fixed, with a twitching of the muscles ; the whole 



AND GUIDE TO HEALTH. 629 

expression is altered; the eyes at first roll, and then 
become stationary, nsnally turned upward; the pupils 
are dilated ; the lips are drawn in many directions, and 
exhibit rapid movements; general distention of the 
countenance, with tumefaction of a livid hue ; foaming 
at the mouth ; protrusion of the tongue ; violent pulsa- 
tion of the carotid and temporal arteries, with marked 
engorgement of the jugulars ; the head, in consequence 
of irregular action of the muscles of the neck, is usually 
drawn to one side. These changes are accompanied by 
spasmodic contractions of the muscles of the arms, 
while the hands are firmly closed — other muscles often 
partake freely of the contractions — the breathing is 
short and irregular, and sometimes momentarily sus- 
pended, through the contractions of the glottis, with 
intermittence of the heart's action. During all this time 
there is complete loss of consciousness. The attack is 
followed by stertorous breathing, the patient present- 
ing the general condition of an apoplectic. After a 
certain time the stertor ceases and consciousness usually 
returns. The attacks may come on every few minutes, 
or hours may intervene between them. These convul- 
sions once witnessed will not likely be forgotten. 

These convulsions may be known from hysteria by the 
entire loss of consciousness, while in hysteria there is no 
loss of consciousness, nor is there frothing at the mouth. 
They may be known from catalepsy by the characteristic 
feature in that disease, which is the uniform persistence 
of the limbs during a paroxysm. They may be known 
from chorea by the disturbance of the mind, while it is 
undisturbed in chorea. That affection consists princi- 
pally in an inability to control muscular movement. It 
may be known from tetanus or lock jaw by the conti- 
nued rigidity of the limbs in lock jaw. It is very hard 



630 THE FAMILY PHYSICIAN 

to distinguish puerperal convulsions from epilepsy; 
about the only difference is the coma that follows puer- 
peral convulsions, which does not follow epilepsy. 

TKEATMENT. 

If possible, the first thing to be ascertained is the 
cause of convulsion ; this may always be done by the 
appearance of the patient, or what you will be able to 
learn of her from her friends or nurse. If you find the 
patient to be plethoric you need not make much inquiry 
as to other facts. You will find a strong, bounding pulse, 
and when this is the case the lancet has to be resorted to 
— but remember, only when there is a full, bounding 
pulse. The custom has been to bleed them at once and 
bleed freely, eight, twelve or sixteen ounces, or until an 
impression is made upon the system. This is wrong. 
But administer a cathartic of senna and salts. Soon after 
give an enema, of castor oil two ounces, molasses two 
ounces, and warm water four ounces. This must all be 
thrown well up into the rectum. Bedford, in his excel- 
lent work on " Obstetrics," recommends oil of croton 
four drops, crushed sugar one teaspoonful (a drachm), 
and mucilage of gum arabic one ounce ; to be taken a 
teaspoonful every fifteen minutes until the bowels are 
moved. After the plethora has been overcome by the 
cathartic, Dover's powders and Hoffman's anodyne should 
be used — five to ten grains of Dover's powders every four 
hours, and forty drops of the anodyne every four hours, 
alternating every two hours. This may be increased if 
necessary. The bowels must be kept in a soluble condi- 
tion, and one teaspoonful of chlorate of potassa saturated 
solution given every three or four hours in a little water. 

If the patient is not plethoric the cause of convulsions 
must be looked for in another direction. It will be found 



AtfD GUIDE TO HEALTH. 631 

in an irritation of the stomach, bowels, bladder, womb 
or vagina ; or in a condition of general anaemia of the 
patient. In any of these conditions, remember, yon are 
not to bleed. If it is in the stomach, give an emetic of 
twenty grains of ipecac dissolved in warm water ; as soon 
as it has operated, an injection of. two ounces of castor 
oil, two ounces of molasses and four ounces of warm 
water must be thrown into the rectum, the patient to take 
one teaspoonful of Hoffman's anodyne in some sweet- 
ened water every two hours ; and as soon as there can be 
an action had on the bowels, Dover's powders in five or 
six grain doses, every four hours. 

If the cause is an irritation of the bowels, get an oper- 
ation from them with senna and salts, and the enema 
above described ; then use the anodyne treatment as 
above recommended. If it is the vagina, inject into 
it half a pint of slippery elm tea or flax seed tea, with 
twenty or thirty drops of laudanum, every hour, and the 
above treatment to the bowels, and the anodyne. If it is 
from the womb, the above treatment must be had recourse 
to ; and if it fails, the contents of the womb may have to 
be expelled. If it arise from a general debility of the 
system, in addition to the above treatment recommended, 
brandy and quinine must be given in medium doses. In 
addition to the above treatment full doses of bromide of 
potassium may be used in any form of puerperal convul- 
sions, and it will be found to do more, perhaps, than any 
other article known in the science of medicine toward 
calming and relieving spasm. In all forms of spasm it 
is worthy of a fair trial. The dose is from three to ten 
grains in water, or in pills, three times a day. 



632 THE FAMILY PHYSICIAN 



PUERPERAL FEVER. 



This fever is produced in lying-in women by a poison- 
ing of the blood. A poison of some description is intro- 
duced into the fluids. Dr. Ferguson says that "the 
phenomena of puerperal fever originate in a vitiation of 
the fluids, and that the various forms of puerperal fever 
depend on this one cause of vitiated blood and are readily 
deducible from it." 

Dr. Bedford says : " But you may very naturally ask, 
what is this poison, and how does it reach the blood ? 
The real essence of the contaminating element it may 
not be so easy to explain ; it is of those mysterious, 
subtile somethings which is more or less frequently met 
with, exhibiting varied pathological phenomena, and 
oftentimes resulting, with remarkable promptitude, in 
the extinction of life. You may call it, after some of 
the older writers, a ferment or a morbific matter, but this 
in no way facilitates the solution of the inquiry — what 
is this poison ?" 

Blood poisoning, toxoemia, is a generic term, and ex- 
hibits several varieties ; in one instance it results in 
scarlet fever, in another in small-pox, in another in 
measles, in another in puerperal fever. 

" If we can not explain," says Bedford, " the essence 
of the poison, yet observation proves that its influence 
on the economy may be very materially affected by cer- 



AND GUIDE TO HEALTH. 633 

tain conditions, such as the state of the atmosphere, the 
locality," etc. 

The testimony is ample, showing a connection between 
puerperal fever and erysipelas. The two diseases may 
prevail simultaneously in the same neighborhood ; or if 
erysipelas alone prevail, a third party may communicate, 
from a patient affected with it, puerperal fever to a woman 
recently delivered. 

Trousseau says : " The lying-in female exhibits a 
peculiar morbid opportunity, and presents a remarkable 
pathological aptitude for the malady." 

Although, as a general rule, puerperal fever attacks the 
parturient female, yet it should be recollected that it is 
not exclusively confined to this class of patients. Young 
women, married, and non-pregnant women, the new-born 
child and the foetus in utero, even when the mother has 
no symptoms of the disease, are all liable to the affec- 
tion. Instances are recorded of its existence under these 
circumstances, and what may surprise you still more, it 
has been shown that, in some cases, the male, if subjected 
to the peculiar poison known to generate the disease, 
will become sick and exhibit lesions more or less in ac- 
cordance with those found in women affected with puer- 
peral fever. Both in the sporadic and epidemic puerperal 
fever the special poison generating the disease may 
originate in the person of the parturient woman and be 
conveyed into her blood through the absorption of putrid 
coagula, portions of placenta, &c. ; but there are other 
modes by which the poison may be communicated. 

Puerperal fever is often, in my opinion, confounded 
with simple peritonitis and metritis, purely accidental 
and, if you choose, sporadic ; totally unconnected with 
epidemic or typhoid influence, and liable to occur from 
cold, or the exercise of any other ordinary agency. 



634 THE FAMILY PHYSICIAN 

IS PUERPERAL FEVER CONTAGIOUS ? 

I do not deem it necessary to cite particular examples 
in which puerperal fever has been conveyed through the 
principle of contagion. They are so numerous and so 
free from all doubt — in a word, they are so conclusive, 
that I can not conceive how they can be regarded other- 
wise than completely demonstrative of the point at issue. 
I have already remarked that puerperal fever may, under 
certain circumstances, originate with the patient herself. 
She may, so to speak, inoculate herself with the noxious 
element through absorption of putrid coagula, or portions 
of the placenta remaining in the uterus ; or she may 
derive the affection from the passage of some of the pro- 
ducts of inflammation into her blood ; or the translation of 
the disease may be by contagion through the interven- 
tion of a third party ; and again, the inoculation may be 
traceable to the hand of the accoucher carrying the poi- 
son into the system during his vaginal explorations. It 
is now, I believe, very generally admitted that the laws 
of contagion can only operate when the disease thus 
communicated is the product of an animal poison ; and 
it is also, in my judgment, clearly established that puer- 
peral fever is rightfully classed among the zymotic dis- 
eases, or those whose existence depends on the presence 
of a noxious animal material. 

Divisions. — There are two distinct varieties of this dis- 
ease — one known as the sporadic^ the other assuming 
the epidemic form. The characteristic of the former is 
that it is an isolated affection, and does not extend; 
while the epidemic variety is not limited to one or two 
cases, but involves districts and neighborhoods, often- 
times proving frightfully destructive to life. 



AND GUIDE TO HEALTH. 635 

SYMPTOMS. 

As a general rule, in the sporadic form, before there is 
the slightest shade of suspicion that puerperal fever is at 
hand, the very first abnormal condition of the patient 
will be an accelerated pulse ; be vigilant, therefore, when 
the pulse becomes quickened after delivery ; although it 
may not be followed by peritonitis, yet it portends evil. 
The disease ordinarily commences its development from 
thirty to forty eight hours after child-birth ; next to the 
quickened pulse will be a rigor of more or less force. 
Succeeding the rigor will be exquisite tenderness over 
the abdominal surface, a heated and dry skin, with a 
pulse ranging from 120 to 160 beats in a minute. The 
tongue is sometimes dry and extremely red ; again it is 
coated and slimy; there is distressing thirst, with a 
respiration rapid and short. Nausea and vomiting 
frequently ensue ; the lochial discharge usually becomes 
suppressed, as also the milk secretion ; but these, in 
some cases, will go on without interruption. Although 
the skin is generally dry and hot at first, as the disease 
advances it becomes moist and clammy. There is a no- 
table change in the countenance — it is expressive of great 
anguish and sunken, with a circumscribed lividity around 
the eyes. The bowels are confined at first, but after- 
ward diarrhea not unfrequently sets in ; the urine is high- 
colored and scant. There is in the progress of the affec- 
tion a marked distention of the abdomen, and this may 
arise from a flatulent condition of the intestines or from 
a sero-purulent effusion, which is one of the ordinary 
attendants on the disease, more especially when it proves 
fatal. Commonly, when the effusion takes place there 
is a cessation of pain, which often deludes the friends 
into false hope, for, under the circumstances, the ab- 



636 THE FAMILY PHYSICIAN 

sence of pain is one of the preludes to death — the other 
fatal symptoms consisting in the extreme rapidity of the 
pulse, which becomes weaker and fluttering, with cold 
extremities ; the patient lapses into unconsciousness ; 
there is a low, unintelligible muttering, together with 
subsultus tendinum or twitching of the muscles. These 
are the closing phenomena, and are soon followed by 
death. One striking characteristic I have not mentioned 
is, the patient remains on her back, with her knees drawn 
up. This position is assumed to relieve the tension of 
the abdomen. 

In the epidemic form of the disorder the symptoms are 
somewhat modified. As a general rule, there is increased 
rapidity of the pulse, and from the violence of the poison 
a depressed condition of the forces is noticeable at the 
very invasion of the malady ; the distension of the abdo- 
men is much earlier developed and the disease is more 
rapidly fatal, sometimes destroying the patient in twenty- 
four or thirty hours. 

It need scarcely be remarked, after what has been said 
about this disease, that the epidemic puerperal fever is 
one of the most fatal disorders of the lying-in room. 
Even in its sporadic type the malady, although much less 
fatal, is full of danger and requires prompt and careful 
treatment. During the progress of the malady the careful 
observer will be enabled to foresee with prophetic truth 
its fatal termination by the presence of certain significant 
indications. You may have abiding faith in the pulse. 
If it should not exceed 120 beats in a minute, it may be 
regarded as most favorable ; but how different if it reach 
and continue at the rate of from 140 to 160. A cessation 
of pain, without any diminution in the pulse, accompa- 
nied with an anxious and drawn countenance, oppressed 
breathing, showing imperfect decarbonization of the 



AND GUIDE TO HEALTH. 637 

blood; involuntary intestinal discharges, the cadaveric 
odor, &c, may justly be regarded as the precursor of 
dissolution. 

"When puerperal fever prevails as an epidemic there 
can be no embarrassment in distinguishing it from other 
disease ; the lines of the affection are so well defined that 
the close observer will readily appreciate its existence. 
The sporadic form may be mistaken for metritis (inflam- 
mation of the womb). By using proper care this need 
mot be ; as in metritis the tenderness is confined to the 
womb, while in puerperal fever the whole abdomen is 
tender and painful. Practically it would make no differ- 
ence if these diseases were confounded in your diagnosis, 
for the treatment would be almost precisely the same. 

TKEATMENT. 

There is too much generalization in the treatment of 
puerperal fever; the same remedies have as a general 
thing been relied upon by practitioners in all cases of the 
fever. This is a fatal mistake, and one reason to my 
mind that it has proved such a scourge to lying-in 
women. One school of practitioners have relied entirely 
upon depletion in every case, while another school, with 
equal confidence and zeal, have relied in every case on 
stimulants and tonics. These are the two extremes, and 
extremes may always be set down as wrong in medicine, 
as well as in politics and religion. If each case of pu- 
erperal fever were of the same grade and exhibited 
the same amount of inflammatory action, the depletory 
course, at least in the commencement, would be but bad 
therapeutics. But it is a fact well known to the medical 
student that there are two distinct grades, differing 
widely. We have, even in its epidemic garb, what may 
be termed inflammatory puerperal fever ; and, again, the 



638 THE FAMILY PHYSICIAN 

disorder will exhibit itself witli all tlie phenomena of 
depression, simulating at the very inception the type of 
a low typhoid affection. If this be so, and its demon- 
stration will be clearly recognized at the bedside, it fol- 
lows as a fundamental principle in therapeutics that 'the 
treatment of the two grades can not be identical. Stim- 
ulants and tonics in the former would certainly prove 
injurious, while depletion in the latter would prove disas- 
trous. The true physician, then, will come to the rescue 
of nature, and when he sees her overwrought will try to 
relieve her of that undue excitement, and when he finds 
her depressed will sustain her. 

At the very commencement of the attack in the inflam- 
matory grade it is well to administer a cathartic. One 
of the following: calomel ten grains, jalap ten grains, 
tartar emetic fourth of a grain, and in two hours give a 
full dose of the citratized magnesia, which must be 
repeated every two hours until free action is had upon 
the bowels. Or, what may be better and more prompt, 
take croton oil four drops, crushed sugar one teaspoonful, 
mucilage of gum arabic one ounce ; to be taken a tea- 
spoonful every fifteen minutes until free action is had 
upon the bowels. Then give ten or twelve grains of 
Dover's powders, and in two hours one grain of opium, 
which must be repeated often enough to keep the patient 
well under the influence of the narcotic. Upon opium 
we must chiefly rely in this disease. It does not always 
require tonics, nutrients or stimulants to assist nature in 
the performance of her labor. Sometimes there is too 
much excitement. This state, if allowed to continue long, 
will produce a corresponding depression. In a case like 
this our duty is plain to lessen the excitement. This 
has generally been done by bleeding, which not only 
lessens it, but robs the system permanently of the suste- 



AND GUIDE TO HEALTH. 639 

nance that it is sure to need before the case is over. The 
crimson fluid of life once drawn from the system can not 
be soon replaced — if, indeed, it ever can. What would "be 
thought of a general who would kill a large portion of 
his own men in order to hasten the attack of the enemy 
and make the contest more equal ? It would be about as 
rational as to destroy, by bleeding, a part of his patient's 
life, and bring on what may be termed the second stage 
more suddenly. When we And nature over wrought it is 
necessary to abate the excitement, which may be done 
by the cathartic and opiates. After the first cathartic 
the bowels must be kept open by injections. In the com- 
mencement of the treatment a flannel cloth should be 
wrung out of warm water, and spirits of turpentine be 
dropped freely upon it, and then laid upon the bowels, 
changing it often. The turpentine emulsion should be 
given all the time every six hours. Ten grains of nitrate 
of potash in a tumbler of water or gruel should be also 
used three or four times a day. This may be termed by 
some rather " heroic treatment," but it is a formidable 
disease, and if the symptoms are not met and checked 
promptly, the practitioner knows too well how fatal the 
consequence will be. The great foe will surely and sud- 
denly claim his victim ; there is no time to be lost ; a 
prompt and judicious stroke must be made or death will 
soon close the unhappy scene. 

In the adynamic form of the disease — that form charac- 
terized at the very commencement by a sinking of the 
forces — the depressed or typhoid grade, depletion is not 
to be attempted. The bowels, however, must be evac- 
uated. This had better be done by the citratized mag- 
nesia in a full dose, and an injection of castor oil one 
ounce, molasses one ounce, brandy one ounce, and warm 



640 THE FAMILY PHYSICIAN 

water three ounces — all to be thrown well up into the 
bowels. 

As soon as action is had npon the bowels quinine in 
five grain doses shonld be given every three hours until 
the peculiar dizziness of the head is felt with the roaring 
in the ears, then the dose should be diminished, but still 
given so as to keep the patient under its influence for 
several days. Brandy toddy may be used at the same 
time or good Port wine. From one-fourth to half a grain 
of morphine or one grain of opium should be given every 
three hours until the patient has got under its influence, 
and then it should be repeated in quantities sufficient to 
keep her under its influence for four or uve days. The 
nitrate or chlorate of potash, or the turpentine emulsion, 
should be used three or four times a day during the 
entire treatment, with the flannel cloth wrung out of 
warm water and turpentine upon the abdomen. 

But, alas ! how often are our best directed efforts made 
negative by the inexorable demands of the merciless 
enemy — death I 

This, however, must not deter us from faithfully per- 
forming our whole duty to the poor sufferer ; by perse- 
verance and energy we can in this disease, as well as 
others, save a human life and rob the grave, at least for 
a while, of its victim. 

Prophylactic or Preventive. — I do not mean by pre- 
ventive that I can offer any advice that will insure the 
lying-in female against puerperal fever. But I have 
already stated that it may be conveyed and communi- 
cated by a third person. Now, what I want to offer is this 
— if the disease is prevailing, persons who have been 
with and waited upon and handled a patient laboring 
under it should not be admitted to the lying-in room ; 
and the physician in attendance on such patient should 



AND GUIDE TO HEALTH. 641 

not wait upon a lady in parturition without first thor- 
oughly washing his hands — not only in soap and water, 
but in a solution of chloride of lime, and brush his nails 
well with a nail brush ; he should also change his 
clothes. No precaution should be neglected when there 
is a possibility of spreading a disease so fearful as puer- 
peral fever. Dr. Semmelweiss has found that puerperal 
fever may be produced by any fluid matter in the state 
of putrefaction, communicated by linen, by a catheter, 
by a sponge, by small particles of the placenta, or even 
by the ambient atmpJio sphere impregnated with the foul 
substances. 

When the disease is prevailing in an epidemic form 
every lying-in chamber should be kept well sprinkled 
with a solution of chloride of lime. Remember, if one 
patient should be saved from an attack of this terrible 
disease, it will amply repay for all your prophylactic 
treatment- 

PUERPERAL MANIA. 

This malady may manifest itself during gestation, at 
the time of labor or some days subsequently ; again, it 
may become developed during the progress of lactation, 
or it may follow weaning. Instances have been recorded 
of its having occurred in very sensitive women immedi- 
ately after conception, yet it is generally conceded that 
it is most liable to become developed a few days after 
delivery and in the progress of advanced lactation. It 
consists in a derangement of the mind, agitation, excite- 
ment, suspicion and irritability of temper ; or it may be 
characterized by a derangement of the mind, moroseness 
and melancholy. It is a disease of irritation and ex- 
haustion* 
41 



642 THE FAMILY PHYSICIAN 

SYMPTOMS. 

Suspicion is a common symptom ; sometimes tliere will 
be marked obstinacy and moroseness ; the husband and 
infant become objects not only of indifference, bnt of 
actual dislike ; tliere may or may not be febrile excite- 
ment ; the pulse is sometimes unchanged, and again it is 
rapid, with more or less fever. The patient will occasion- 
ally become extremely violent in manner and language, 
and much vigilance will be required to prevent her from 
inflicting injury upon herself and child. A very uniform 
and early symptom is restlessness soon after delivery 
and inability to sleep ; the patient is wakeful, throwing 
herself about the bed and sometimes sighing. This state 
of watchfulness should always be regarded with appre- 
hension, and means promptly employed to procure sleep. 
The digestive functions are much disturbed, the tongue 
coated and slimy, the bowels irregular and the urinary 
secretions defective. These are the symptoms character- 
izing one form of the mania. 

In the other form of mania— melancholic — the symp- 
toms are somewhat different. Here, in lieu of excitement 
and violence, there is marked depression of spirits ; there 
is, if I may so term it, a deep melancholy pervading every 
look and act of the invalid ; she is silent, listless and in- 
different to everything passing around her ; the pulse is 
normal, with more or less deranged digestion. In one 
word, she is an object painful to contemplate, and presents 
one of those pictures in real life well calculated to deeply 
impress the observer and call forth his sympathies. The 
prognosis may ordinarily be favorable. I say ordinarily, 
for there are occasionally certain conditions of the dis- 
order which portend a fatal result. These conditions 
are, rapid pulse and continued restlessness at the very 



AND GUIDE TO HEALTH. 643 

inception of the malady. When they exist conjointly 
they are to be regarded as tokens of no good. Happily 
the great majority of cases are not characterized by the 
quickened pulse, although watchfulness is a common at- 
tendant. The average duration of the malady, under 
judicious treatment, may be set down at from a few days 
to six months, while a permanent aberration of mind is 
the exception. 

TREATMENT. 

I have said before that the disease is one of exhaus- 
tion and irritation. With this cardinal fact before you, 
you will have the key to the treatment. Your course 
will be to repair the waste the system has undergone and 
allay the irritation. The first can be accomplished only 
by nutriment ; but nutrition is not an exclusive process, 
it is but one link in a chain of processes. Food taken 
into the stomach will not furnish nutriment unless the 
digestive apparatus does its part and the food is digested. 
I have already said that the digestion in this disease is 
disordered, as shown by the coated tongue, fetid breath, 
loss of appetite and irregularity of the bowels. There- 
fore, the broad indication is to administer a cathartic. 
For this purpose, take six grains of calomel and twelve 
grains of rhubarb ; follow this in about six hours with a 
dose of castor oil or a Seidlitz powder or the citratized 
magnesia. 

If there be much heat about the head evaporating 
lotions must be applied, with warmth to the feet by means 
of warm bricks or bottles of hot water. If there be much 
febrile excitement sweet spirits of nitre may be given, 
one teaspoonful every hour in two tablespoonfuls of cold 
water, and aperients used, such as citratized magnesia, 
When proper action is had upon the bowels and the 



644 THE FAMILY PHYSICIAN 

febrile excitement is subdued, which will soon be done, 
the next and most important thing to be attended to is 
the irritability of the system, and the sooner sleep can be 
induced the better. For this purpose, take Hoffman's 
anodyne one ounce and add to it two grains of sulphate of 
morphine ; give one teaspoonful of this preparation in 
two tablespoonfuls of sweetened water every two hours 
until an impression is made. The patient must be 
allowed a generous and nutritious diet; articles easily 
digested should be selected, and if it is not contra-indi- 
cated she should be allowed animal food freely. Remem- 
ber, the great object is to build up the system and allay 
the irritability. For this reason her room should be kept 
quiet, and nothing allowed that would be calculated to 
excite or irritate her in the least ; above all, meddlesome 
and inquisitive friends must not be allowed in her room. 
She should never be left alone for a moment, for fear she 
should commit some act of violence on her person. In- 
stances are not wanting in which this has been done. As 
she recovers, her mind should be pleasantly occupied by 
pleasant conversation, drives in the country, good music, 
etc., etc. 



AND GUIDE TO HEALTH. 645 



PHLEGMASIA DOLENS-'MILK LEG." 



This disease is generally known in this country by the 
name of milk leg. It consists of imflammation of the 
veins of one of the legs, generally the left leg, but it may 
attack both ; this, however, is very rare. In fact, the dis- 
ease is a rare one, only occurring, according to statistics, 
about once in four or five hundred cases. 

SYMPTOMS. 

The prominent symptom in " milk leg " is pain and 
swelling. It usually develops itself a short time after 
parturition ; it may be developed during pregnancy, or, 
according to some writers, in the non-pregnant female. It 
usually commences with pain in the groin, followed soon 
by swelling, and always extending downward ; sometimes 
the pain will commence in the calf of the leg. When it 
commences in the thigh the femoral vein at the groin can 
be felt with the finger and traced down the thigh ; it im- 
parts a sensation of hardness and rolls under the finger 
like a cord. Pressure upon this vein occasions intense 
suffering, while pressure on any other part occasions 
very little, if any, pain. Sometimes the first symptom 
experienced is a chill of more or less duration. Again, 
the first indication is a pain in one or the other side 
of the pelvis. The symptoms are not at all uniform, and 
very nearly resemble in many respects those of iliac and 



64.6 THE FAMILY PHYSICIAN 

crural phlebitis. As above stated, pain and swelling of 
the leg are the prominent symptoms. 

TBEATMENT. 

The treatment should commence with a" cathartic. 
Some of the salines should be used for this purpose — 
the citratized magnesia in full dose will answer an excel- 
lent purpose. The indications are, first, to subdue the 
inflammation, then to bring about absorption of the 
effused fluids and establish a healthy action of the veins. 
For this purpose the bowels must be kept in a soluble 
condition by the use of the saline cathartics and the 
nitrate of potash, given three times a day in twelve or 
fifteen grain doses in a tumbler of water or gruel. 

Sulphate of morphine should be given the patient in 
one-fourth to half grain doses to quiet the general irrita- 
bility of the system, (which is always a prominent symp- 
tom) and to procure sleep. 

After the inflammatory symptoms have begun to sub- 
side a warm bran poultice applied to the limb will afford 
much relief; the belladonna ointment smeared over 
the limb, or a liniment of equal parts of chloroform 
and sweet oil rubbed on the limb, will usually prove 
advantageous. 

If the liver appears sluggish, with a dry skin, eight 
grains of blue mass at night, with Seidlitz's powders 
enough in the morning to move the bowels, should be 
used. After the inflammatory symptoms have passed 
away, measurably, which will be in four or five days, the 
iodide of potassium should be taken. Take iodide of 
potassium two drachms, water four ounces — dissolve and 
give one teaspoonful three times a day in two table- 
spoonfuls of sweetened water. This must be continued 



AND GUIDE TO HEALTH. 647 

for three or four weeks. If the patient seems irritable 
and restless at any time she should have morphine. If 
she should become feeble she must have good, nourishing, 
easily digested, nutritious food; she may also be 
allowed some good Port or, what is better, Norton's 
Virginia Seedling wine, or she may require some 
quinine. The limb should be kept in a horizontal posi- 
tion, and great care taken when the patient begins to 
Improve that she does not get a relapse and bring the 
disease into a regular chronic state, from which it would 
take it a great while to recover, if, indeed, it ever did. 



INFLAMMATION OF THE WOMB. 

METRITIS. 



This disease seldom occurs except in women who have 
aborted, or in parturient women, in whom it may occur 
at a period varying from three days to one or two weeks 
after delivery. The inflammation is confined to the 
proper substance of the womb. 

SYMPTOMS. 

A hot, dry skin, preceded by a general feeling of chil- 
liness and nausea, pain in the head, thirst, furred tongue, 
rapid pulse, and all the symptoms common to inflamma- 
tion. The characteristic symptom is a constant pain in 
the womb. 



648 THE FAMILY PHYSICIAN AND GUIDE TO HEALTH. 
TEEATMENT. 

The same as recommended for puerperal fever , with 
the exception that warm water injections will be fonnd 
very useful in the treatment of inflammation of the 
womb, both as auxiliary and to keep the parts clean. 

The disease runs its course pretty rapidly, and the 
treatment must be prompt. It terminates favorably by 
resolution, or unfavorably by abscess, softening, of the 
womb 01 gangrene. 

The general treatment in this disease should not differ 
from the general treatment of inflammation. The pa- 
tient must .'be sustained or the disease will crush her; 
not only is this the case in this, but in all other diseases.. 



3 47 7 4 



